To determine which clinical and radiographic findings are valuable in selecting patients with blunt chest
trauma for aortography, we analyzed the medical records and admission chest radiographs of 76 consecutive victims of blunt chest
trauma with suspected thoracic
aortic rupture during the past 7 years. All patients were evaluated by history, physical examination, chest radiography, and aortography; a total of 70 clinical and radiographic findings were independently assessed in each patient. The following occurred with significantly greater frequency in patients with thoracic
aortic rupture than in those without: history of significant
hypotension (mean arterial pressure less than 80 mm Hg) (p less than 0.04); the presence of upper extremity
hypertension, bilateral lower extremity pulse pulse deficits, or an initial
chest tube output greater than 750 ml of blood (p less than 0.05); and greater incidence of
myocardial contusions, intra-
abdominal injuries, and pelvic fractures compared with patients without thoracic
aortic rupture (p less than 0.05). Mediastinal widening (equal to or greater than 8 cm) shown on anteroposterior chest radiography occurred in all patients with thoracic
aortic rupture; however, its specificity was only 10.6%. Radiographic signs that were helpful in indicating the presence of thoracic
aortic rupture included paratracheal stripe greater than 5 mm, rightward deviation of the nasogastric tube or central venous pressure line, blurring of the aortic knob, and an abnormal or absent paraspinous stripe. Upper
rib fractures and mediastinal to thoracic cage width ratios at any level did not increase diagnostic accuracy for thoracic
aortic rupture in the present series. Six patients in the series died, two of whom had thoracic
aortic rupture.(ABSTRACT TRUNCATED AT 250 WORDS)