Mirvis S E, Bidwell J K, Buddemeyer E U, Diaconis J N, Pais S O, Whitley J E, Goldstein L D
Radiology. 1987 May;163(2):487-93. doi: 10.1148/radiology.163.2.3562831.
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.
对205例钝性胸部创伤患者的胸部X线片进行回顾性分析，这些患者同时接受了主动脉造影。205例患者中有41例经主动脉造影证实存在主动脉破裂。对16种影像学征象进行判别分析表明，最具判别力的征象是主动脉肺动脉窗消失、主动脉弓异常、气管右移以及左椎旁线增宽且无相关骨折。没有单一的或组合的影像学征象显示出足够的敏感性，能够在不进行大量主动脉造影阴性检查的情况下，在胸部平片上提示所有创伤性主动脉破裂病例。事实证明，胸部的床边前后位“直立”视图在检测真阴性病例方面远比仰卧位视图有价值。尽管不同读者对各种影像学征象的解读存在显著差异，但总体而言，该分析证实了胸部X线检查在这种临床情况下的作用，但表明其最有益的用途是排除诊断并避免不必要的主动脉造影，而不是预测主动脉破裂。
