One of my colleagues had a patient come in after a high-speed motor vehicle collision (MVC) and the patient turned out to have a blunt aortic injury (BAI). Luckily she saved the images for EMREMS:
1. The ETT tube is slightly high, this was corrected (see Post Intubation Eval)
2. Chest tube is inserted in the left side and the patient has subcutaneous emphysema. The chest tube could have been put in further but seems to be working.
3. Notice the loss of normal contour of the aortic knob (aka “indistinct aortic knob”).
4. The trachea is displaced to the patient’s right
5. The upper mediastinum seems a little wide although not drastically.
6. There is loss of the aortopulmonary window (AP window)
For comparison I have a normal AP Chest Xray and have arrows pointing to the normal AP window and aortic knob:
The patient’s Chest Xray is worrisome for traumatic aortic dissection. Here is the patient’s Chest CT which confirms the diagnosis:
In the first image one can see a rough inner surface of the aorta indicating intimal disruption and hematoma. A dissection flap can be seen in the second image. Hematoma can be seen on both images surrounding the aorta and tracking in the mediastinum.
What are some other signs on Chest Xray that would get you worried about BAI? (Comments are encouraged)
Stay tuned in the future for a “Radiology Rules” 3X5 card with Chest Xray signs of BAI.
Author: Russell Jones, MD
Image contributor: Kendra Grether-Jones, MD