Value of chest radiography in excluding traumatic aortic rupture.

TLDR

The study retrospectively reviewed chest radiographs from 205 blunt chest trauma patients who underwent aortography. Forty‑one of 205 patients had aortic rupture, and although discriminant analysis identified several radiographic signs, none had sufficient sensitivity to reliably detect rupture, so chest radiography is most useful for excluding traumatic aortic rupture and avoiding unnecessary aortography, with the erect AP view being superior to the supine view.

Abstract

A retrospective review of chest radiographs from 205 patients with blunt chest trauma who also underwent aortography was performed. Forty-one of the 205 had aortographically proved aortic rupture. Discriminant analysis of 16 radiographic signs indicated that the most discriminating signs were loss of the aorticopulmonary window, abnormality of the aortic arch, rightward tracheal shift, and widening of the left paraspinal line without associated fracture. No single or combination of radiographic signs demonstrated sufficient sensitivity to indicate all cases of traumatic aortic rupture on plain chest radiographs without the performance of a large number of aortographically negative studies. The bedside anteroposterior "erect" view of the chest proved far more valuable than the supine view in detecting true-negative studies. Despite significant reader variability in the interpretation of the various radiographic signs, in general the analysis confirmed the role of chest radiography in this clinical situation, but suggests that its most beneficial use is in excluding the diagnosis and eliminating unwarranted aortography rather than in predicting aortic rupture.