Teaching Points
- Diagnosis depends on the level of clinical suspicion and imaging
- The initial screening tool for blunt thoracic trauma is a supine radiograph
- Patients who have an abnormal supine film (or normal erect chest Xray with high clinical suspicion) and are cardiovascularly stable should undergo CT of the mediastinum
- Absence of peri-aortic mediastinal haematoma and direct signs of aortic injury on CT has a very high negative predictive value for aortic trauma
- Those who have an abnormal supine film and who are cardiovascularly unstable, should be referred for an urgent surgical opinion
- An aortogram can be used for diagnostic and therapeutic purposes (eg stenting)
- The role of Trans-Oesophageal Echocardiogram in the assessment of blunt thoracic trauma remains to be fully elucidated
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