Certain findings on chest X-rays or other imaging studies should raise the suspicion that the patient may have an injury involving a great vessel within the thorax. This can help identify those patients in whom more specific diagnostic studies are indicated.


Classes of findings:

(1) certain fractures (see below)

(2) mediastinal changes (see below)

(3) findings on lateral chest X-rays (see below)

(4) miscellaneous findings (see below)



(1) clavicle in patients with multi-system injury

(2) multiple left ribs

(3) scapula

(4) sternum

(5) possibly the first rib


Mediastinal changes:

(1) obliteration of the aortic knob contour

(2) widening of the mediastinum > 8 cm

(3) depression of the left mainstem bronchus > 140 degrees from trachea

(4) loss of paravertebral pleural stripe

(5) calcium layering at the aortic knob

(6) "funny looking" mediastinum

(7) lateral displacement of the nasogastric tube (in the esophagus)

(8) lateral displacement of the trachea


Findings seen on lateral chest radiographs:

(1) anterior displacement of the trachea

(2) loss of the aortic/pulmonary window


Miscellaneous findings:

(1) obvious blunt injury to the diaphragm

(2) massive left hemothorax

(3) apical pleural hematoma


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