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A 43-year-old male with a history of schizoaffective disorder is brought to the emergency

room after falling from the third floor of an apartment building. He appears scared and
points to his chest asking for help. His blood pressure is 137/91 mmHg and his heart
rate is 120/min. Chest x-ray is shown below.

What is the most likely diagnosis?

0 A. Myocardial contusion
0 B. Left ventricular aneurysm
0 C. Aortic injury
0 D. Hemothorax
0 E. Pulmonary contusion
0 F. Tracheobronchial disruption
0 G. Diaphragm rupture

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0. ld : 4696 Previous Next Lab Values Notes Calculator Reverse Color Text Zoom

A 43-year-old male with a history of schizoaffective disorder is brought to the emergency

room after falling from the third floor of an apartment building. He appears scared and
points to his chest asking for help. His blood pressure is 137/91 mmHg and his heart
rate is 120/min. Chest x-ray is shown below.

What is the most likely diagnosis?

A Myocardial contusion [8%)

B. Left ventricular aneurysm [1%)
v C. Aortic injury [67%)
' D. Hemothorax [5%)
E. Pulmonary contusion [9%)
F. Tracheobronchial disruption [4%)
G. Diaphragm rupture [5%)

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Ex planation: User ld

Enlarged, widened aortic arch

contour obscuring the pulmonary artery

For patients involved in motor vehicle accidents or falls from > 10 feet, physicians must
have a high suspicion for blunt aortic injury. Blunt aortic injury carries a high mortality
rate, making expeditious detection and treatment critical. Though clinical signs and
symptoms are highly variable, anxiety, tachycardia and hypertension are common.
Therefore, radiographic Imaging is critical to diagnosis and should be obtained whenever
the mechanism of injury raises suspicion for blunt aortic injury. Chest x-ray is an
appropriate initial screening study. Mediastinal widening is the most sensitive finding for
blunt aortic injury. Deviation of the trachea or nasogastric tube to the right or depression
of the left main stem bronchus may also be seen. Here the chest x-ray shows substantial
mediastinal widening, sufficient for diagnosis. Where the history and chest x-ray findings
are equivocal, chest CT and angiography are appropriate.

(Choice A ) Myocardial contusion may also result from blunt trauma. Tachycardia is a
common sign, and chest x-ray may demonstrate rib fractures, a common cause of cardiac
contusion. Mediastinal widening is not seen with myocardial contusion alone.

(Choice B) Left ventricular (LV) aneurysm may present on chest x-ray as a prominence
or bulge along the left heart border. LV aneurysm is most commonly seen as a
 For patients involved in motor vehicle accidents or falls from > 10 feet, physicians must
have a high suspicion for blunt aortic injury. Blunt aortic injury carries a high mortality
rate, making expeditious detection and treatment critical. Though clinical signs and
symptoms are highly variable, anxiety, tachycardia and hypertension are common.
Therefore, radiographic imaging is critical to diagnosis and should be obtained whenever
the mechanism of injury raises suspicion for blunt aortic injury. Chest x-ray is an
appropriate initial screening study. Mediastinal widening is the most sensitive finding for
blunt aortic injury. Deviation of the trachea or nasogastric tube to the right or depression
of the left main stem bronchus may also be seen. Here th e chest x-ray shows substantial
mediastinal widening, sufficient for diagnosis. Where the history and chest x-ray findings
are equivocal, chest CT and angiography are appropriate.

(Choice A) Myocardial contusion may also result from blunt trauma. Tachycardia is a
common sign, and chest x-ray may demonstrate rib fractures, a common cause of cardiac
contusion. Mediastinal widening is not seen with myocardial contusion alone.

(Choice B) Left ventricular (LV) aneurysm may present on chest x-ray as a prominence
or bulge along the left heart border. LV aneurysm is most commonly seen as a
complication of transmural myocardial infarction, and is not associated with trauma. It is
best diagnosed by echocardiogram.

(Choice D) Hemothorax is indistinguishable from pleural effusion on chest x-ray.

Blunting of the costophrenic angle, or even partial to complete opacification of one
hemithorax might be expected from a significant hemothorax.

(Choice E) Pulmonary contusion is the most common finding after blunt chest injury.
Chest x-ray reveals opacities caused by hemorrhage in the involved lung segments.

(Choice F) A tracheobronchial disruption may cause pneumothorax, mediastinal

emphysema and/or subcutaneous emphysema on chest x-ray.

(Choice G) A traumatic diaphragmatic rupture is identified by the herniation of abdominal

contents (stomach, intestine, spleen) into the thorax.

Educational objective:
For any patient who suffers blunt deceleration trauma (MVA or fall from> 10 feet), blunt
aortic trauma must be ruled out. Chest x-ray is the initial screening test, and widening of
the mediastinum is the most sensitive finding.

Time Spent: 3 seconds Copyright© UWorld Last updated: [09/09/2016)

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