ROUTINE HELICAL COMPUTED TOMOGRAPHIC EVALUATION OF THE MEDIASTINUM INHIGH-RISK BLUNT TRAUMA PATIENTS

Background: The indications and method of evaluation of the mediastinu m in blunt deceleration trauma are controversial and vary among center s. Most centers practice a policy of angiographic evaluation only in t he presence of an abnormal mediastinum on chest radiography. Routine a ortography in the absence of any mediastinal abnormality is not widely practiced. Helical computed tomographic (CT) scan has been successful ly used in recent studies in the evaluation of the thoracic aorta. Obj ective: To determine the role of routine helical CT scan evaluation of the mediastinum in patients involved in high-speed deceleration injur ies, irrespective of chest radiographic findings. Design: A prospectiv e study over a 1-year period. Included in the study were patients with high-speed deceleration injuries who required CT evaluation of the he ad or abdomen. This group of patients underwent routine helical CT eva luation of the mediastinum irrespective of chest radiographic findings . Setting: Large, urban, academic level I trauma center. Results: A to tal of 112 trauma patients fulfilled the criteria for study inclusion. Overall, there were 9 patients (8.0%) with aortic rupture. Four (44.4 %) of these patients had a normal mediastinum on the initial chest xra y film and the diagnosis was made by CT scan. The CT scan was diagnost ic in 8 of the aortic ruptures (intimal tear or pseudoaneurysm) and wa s suggestive of aortic injury but not diagnostic in 1 patient with bra chiocephalic artery injury. In 42 patients (37.5%), there was a widene d mediastinum: an aortic rupture was diagnosed in 5 of them (11.9%) an d a spinal fracture in 9 (21.4%). One patient had both aortic rupture and spinal injury. Conclusions: The incidence of aortic injury in pati ents with high-speed deceleration injury is high. A significant propor tion of patients with aortic injury have a normal mediastinum on the i nitial chest radiograph. There is a high incidence of spinal injuries in the presence of a widened mediastinum. We recommend that all trauma patients with high-risk deceleration injuries undergo routine helical CT evaluation of the mediastinum irrespective of chest radiographic f indings.