- Left "apical cap"
- Deviation of nasogastric (NG) tube rightward
- Deviation of trachea rightward
- Deviation of right mainstem bronchus downward
- Wide left paravertebral stripe
Your major concern?
Answer: Blunt aortic injury (BAI)
BAI is a trauma emergency. Initial bedside CXR is a great way to look for signs of BAI. Following features on CXR warrants emergent intervention or CT chest if clinical stability permits.
1. Ho ML, Gutierrez FR. Chest radiography in thoracic polytrauma. AJR Am J Roentgenol 2009; 192:599.
2. Marnocha KE, Maglinte DD, Woods J, et al. Blunt chest trauma and suspected aortic rupture: reliability of chest radiograph findings. Ann Emerg Med 1985; 14:644.
3. Ekeh AP, Peterson W, Woods RJ, et al. Is chest x-ray an adequate screening tool for the diagnosis of blunt thoracic aortic injury? J Trauma 2008; 65:1088.
BAI is a trauma emergency. Initial bedside CXR is a great way to look for signs of BAI. Following features on CXR warrants emergent intervention or CT chest if clinical stability permits.
- Wide mediastinum (8 cm if supine or 6 cm if upright)
- Obscured aortic knob
- Abnormal aortic contour
- Pleural blood above the apex of left lung (known as apical cap)
- Signs of left hemothorax
- Deviation of NG tube rightward
- Deviation of trachea rightward
- Deviation of right mainstem bronchus downward
- Wide left paravertebral stripe
#trauma
References:
1. Ho ML, Gutierrez FR. Chest radiography in thoracic polytrauma. AJR Am J Roentgenol 2009; 192:599.
2. Marnocha KE, Maglinte DD, Woods J, et al. Blunt chest trauma and suspected aortic rupture: reliability of chest radiograph findings. Ann Emerg Med 1985; 14:644.
3. Ekeh AP, Peterson W, Woods RJ, et al. Is chest x-ray an adequate screening tool for the diagnosis of blunt thoracic aortic injury? J Trauma 2008; 65:1088.
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