Ruptured thoracic aorta: evolving radiological concepts.

The chest roentgenograms of 18 patients with ruptured aortas were studied and the radiographic features tabulated. Fifteen patients survived to undergo angiography, and 14 aortograms were available for review. Distortion of the normal aortic contour and blurring of the aortic outline occurred on the initial chest film in each of the 18 cases. Obliteration of the medial left upper lung field and displacement of the superior vena cava to the right were observed in 16 and 15 films, respectively. Increased mediastinal width was not the most common noted abnormality. The mean mediastinal width on 100 cm anteroposterior supine chest film was 8.8 cm. One patient exhibited a mediastinal width within the normal range. Other frequently occurring abnormalities included opacification of the clear space between the aorta and pulmonary artery, obliteration of the distal aortic shadow, and tracheal shift to the right. At aortography nine patients demonstrated both linear radiolucent defects across the aorta and pseudoaneurysm formations, three patients showed only pseudoaneurysms, and two exhibited only linear radiolucent defects.