Acute mediastinal widening following blunt chest trauma: critical decisions.

Abstract

We have treated 16 cases of blunt injury to the chest which produced mediastinal widening. Included in this series is a unique experience with two motorcyclists hitting the same car and developing identical aortic tears. Aortography was invaluable in defining the responsible lesion. Of seven patients with acute aortic rupture, two had normal x-ray films of the chest initially, and in three, mediastinal widening was only appreciated retrospectively, emphasizing the need for frequent serial x-ray films of the chest. Successful repairs were accomplished in both patients on whom this was attempted, without cardiopulmonary bypass and in three out of four with bypass. One patient exsanguinated prior to the operation. All three chronic, traumatic, aortic aneurysms were resected successfully. Six patients had mediastinal hematomas without aortic injury. Of four with normal aortograms who did not have surgery, two died of associated injuries. Of the other two patients who underwent exploration because of subclavian artery defects, one died.