CASE 564 Published on 06.11.2000

Teaching Case

Section

Chest imaging

Case Type

Clinical Cases

Authors

M. Wintermark, P. Schnyder

Patient

31 years, male

Categories

No Area of Interest ; Imaging Technique CT ;

No Procedure ; No Special Focus ;

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Clinical History

High-speed motorcycle accident

Differential Diagnosis List

Compressive hemomediastinum with an unidentified arterial origin

Imaging Findings

31-year-old male driver ejected from his motorcycle

Discussion

Mediastinal widening is diagnosed when the mediastinum width to chest width ratio, at the level of the aortic arch, is superior to 0.25. It is related with an aortic lesion in about 20% of cases, but may also result from other major mediastinal vessel injuries or from small vessel lesions consecutive to clavicular, sternal, rib or vertebral fractures. Finally, widened mediastunum in trauma patients may be secondary to abundant fluid perfusion with superior vena cava distension or to patient’s supine position. Spiral chest CT and/or transesophageal echography are sensitive screening imaging modalities to rule out life-threatening aortic injuries. Rarely, a thoracic aortography is needed to complete this screening survey.

References

[1] Heystraten FM, Rosenbusch G, Kingma LM, et al.
Chest radiography in acute traumatic rupture of the thoracic aorta.
Acta Radiol 1988;29: 411-417. (PMID: 3408601)

[2] Huang P, Fong C, Rademaker A.
Prediction of traumatic aortic rupture from plain chest film findings using stepwise logistic regression.
Ann Emerg Med 1987;16: 1330-1333. (PMID: 3688593)

[3] Lacqua MJ, Sahdev P. Widened mediastinum in acute trauma: a complication of central venous catheterization.
J Emerg Med 1994;12: 607-609. (PMID: 7989686)

[4] Mirvis SE, Bidwell JK, Buddemeyer EU, et al.
Value of chest radiography in excluding traumatic aortic rupture.
Radiology 1987; 163: 487-493. (PMID: 3562831)

[5] Wintermark M, Wicky S, Bettex D, et al. Trauma of the mediastinum. In Schnyder P, Wintermark M. Radiology of blunt trauma of the chest. Springer, Berlin Heidelberg (2000).

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