The significance of chest wall injury in the diagnosis of traumatic aneurysms of the thoracic aorta.

It has been suggested that patients sustaining blunt chest injury severe enough to result insignificant bony injury to the thorax may have traumatic aneurysms of the thoracic aorta in the absence of th widened mediastinum on plain film. To test the validity of this hypothesis, we performed aortograms on 14 patients with severe blunt chest injury but an otherwise normal chese X-ray. None of these patients was found to have an aortic injury. By contrast, of 21 patients with severe chest injury and a widened mediastinum who underwent thoracic aortography eight were found to have traumatic aneurysms of the thoracic aorta. These results suggest that in the absence of a widened mediastinum, severe chest wall injury is not an indication for aortography.