The Widened Mediastinum in Trauma

Abstract

Twenty-four patients with widened mediastinum were studied, of whom 7 had ruptured thoracic aorta, 8 had mediastinal hematoma, 6 had paravertebral hematoma, and 3, due to faulty diagnostic technique, appeared to have widened mediastinum. Nine patients underwent operation with 5 surviving; 3 had acute aortic rupture, 2 had delayed aortic aneurysm, 1 had avulsion of retrosternal tissues, 2 had ruptured intercostal and mammary vessels, and 1 had an atheromatous plaque mimicking aortic rupture. Wide mediastinum is caused by aortic rupture or mediastinal hematoma, but poor radiographic technique can lead to a mistaken diagnosis. The plain chest film and the aortogram are essential for the proper diagnosis of widened mediastinum in trauma.