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Case of the Week

The above patient presents to the ER after an MVA. Currently, the only symptoms are minimal pain with movement of the cervical spine, however the driver of the MVA was pronounced dead at the scene. Routine XRays and labs are obtained in accordance with trauma protocol, and the CXR is as above. What is the diagnosis and what are the CXR signs pointing to this diagnosis?

 

This patient has a widened mediastinum and traumatic aortic rupture must be considered. Xray signs include:

Mediastinal width greater than 6cm in a PA film or 8cm in an AP film

Obscured aortic knob

Displaced NGT

Opacification between the aorta and pulmonary artery

Depression of the left mainstem bronchus (more than 40 degrees from horizontal)

Left apical pleural cap

Left Hemothorax

Deviation of the trachea to the right

Multiple rib fractures (especially the first and second ribs)

 

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