A 28-year-old woman is brought after a high-speed motor vehicle collision. She is confused, BP 80/50 mmHg, HR 130/min, SpO2 90%. Chest X-ray shows a widened mediastinum, depressed left mainstem bronchus, and deviation of the nasogastric tube to the right. What is the most likely diagnosis and immediate intervention?
- A Tension pneumothorax; immediate needle thoracostomy
- B Traumatic diaphragmatic rupture; urgent laparotomy
- C Traumatic aortic injury; CT angiography and blood pressure control ✓
- D Cardiac tamponade; pericardiocentesis
Correct answer: C. Traumatic aortic injury; CT angiography and blood pressure control
Explanation
Widened mediastinum, depressed left mainstem bronchus, and nasogastric tube deviation to the right are classic signs of traumatic aortic injury (thoracic aortic disruption), typically at the ligamentum arteriosum. CT angiography confirms the diagnosis. Immediate management includes blood pressure control with beta-blockade and endovascular or open repair. Tension pneumothorax would show tracheal deviation and absent breath sounds.
Reference: Trauma (Mattox, Feliciano, Moore), 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.