RADIOGRAPHIC AND CT FINDINGS OF BLUNT CHEST TRAUMA - AORTIC INJURIES AND LOOKING BEYOND THEM

Increasingly, helical CT is being used to screen trauma patients for a ortic injury. Most aortic injuries visible at CT occur at or near the level of the ligamentum arteriosus; these injuries manifest as mediast inal hematoma, aortic contour deformity, intimal naps, intraluminal de bris, pseudoaneurysm, and pseudocoarctation. In the process of searchi ng for aortic injury, however, the radiologist should not overlook oth er serious and more common thoracic injuries. Tracheobronchial tears a ppear at CT and radiography with persistent pneumothorax, subcutaneous emphysema, ''fallen lung'' sign, and malposition of endotracheal tube . The ruptured diaphragm, which tears more often on the left, appears asymmetric, irregular, or discontinuous, with herniation of bowel or v iscera into the chest. In esophageal rupture, CT and radiography demon strate left pneumothorax, pneumomediastinum, subcutaneous emphysema, a nd pleural effusion and atelectasis on the left. CT is better than tra uma radiography for depicting fractures of the thoracic vertebral bodi es and ribs, as well as for revealing pulmonary contusions and lacerat ions. CT is also useful for demonstrating unsuspected injuries caused by seat belts. Observation of these injuries should prompt a search fo r other serious internal organ injuries.