Significance of a Widened Mediastinum in Blunt Chest Trauma Patients
SUVIT SRIUSSADAPORN, M.D.*, VICHAI BENJACHOLAMAS, M.D.*, KITTICHAI LUENGTAVIBOON, M.D.*, SERI SINGHATANADGIGE, M.D.*
Affiliation : *Department of Surgery, Faculty of Medicine, Chulalongkom University, Bangkok 10330, Thailand.
Eighteen blunt chest trauma patients who had mediastinal widening on chest roengenogram
were studied for the correlation with traumatic ruptured of the aorta or its major branches. Seven-
teen patients were male and one was female. The age ranged from 18 to 39 years, mean 26.17±
6.85SD. The Injury Severity Score (ISS) ranged from 9 to 34, mean 25.5±6.49SD. Fourteen patients
(77 .8%) sustained motorcycle accidents, 3 patients ( 16.7%) sustained car accidents and 1 patient
(5.5%) fell from a 4 storey building. All patients underwent aortography to search for traumatic
rupture of the aorta or its major branches. Six patients had computed tomography of the chest
before aortography. Nine patients (50%) had normal aortography. The remaining 9 patients who had
positive aortography underwent urgent thoracotomies, 8 of them had traumatic rupture of the aorta
or its major branches, the remaining 1 patient had normal operative finding. Of the 8 patients who
had traumatic rupture of the aorta or its major branches, 1 patient died. The mortality was 12.5
per cent.
The rate of traumatic rupture of the aorta or its major branches in patients who had blunt
chest trauma and widening of the mediastinum on chest roengenogram in our study was 44.4
per cent. The sensitivity of aortography for diagnosis of traumatic rupture of the aorta or its major
branches was 100 per cent and the specificity was 90 per cent. On the basis of this study, we con-
clude that blunt chest trauma patients with widened mediastinum on chest roengenogram have a
significantly high rate of traumatic rupture of the aorta or its major branches. All blunt chest
trauma patients who have widened mediastinum on chest reongenogram should undergo further
investigations to exclude traumatic rupture of the aorta or its major branches. We recommend
aortography as the investigation of choice due to its accuracy and usefulness in management
plan.
Keywords : Widened Mediastinum, Blunt Chest Trauma, Traumatic Rupture of the Aorta, Aortography
