Abnormal Chest Roentgenogram Research Articles

Burden of Human Metapneumovirus and Respiratory Syncytial Virus Infections in Asthmatic Children.

Human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) are the leading causes of acute respiratory illness in children. Clinical burden of each infection on the respiratory distress in asthmatic patients remains unclear. The purpose of the study was to clarify the effect of these infections on the severity of asthmatic children in the seasonal outbreaks. A total of 1,217 pediatric inpatients with hMPV (n = 114) or RSV (n = 1,103) infection in Yamaguchi prefecture, Japan, between 2011 and 2014 were enrolled. Bronchial asthma was defined as having more than 3 episodes of wheezing illness over 1 year of age. Infection was determined by the positive antigen test for each virus in the nasal specimens. The number of patients peaked at age 12-15 months in hMPV infection and at age 0-3 months in RSV infection. The proportion of hypoxic patients (40-50%) did not differ at any age between hMPV-infected and RSV-infected children. In the analysis of date from > 1 year old patients with hypoxia, hMPV-infection group was older (P = 0.036), and more frequently had history of asthma (P = 0.015) or abnormal chest roentgenogram (P < 0.001) than RSV-infection group. Multivariate analysis indicated that the hypoxia-associated factors were history of asthma in both hMPV (odds ratio [OR]: 15.8; P < 0.001) and RSV infections (OR, 2.2; P = 0.005), higher body temperature in hMPV infection (OR, 2.2; P = 0.009), and younger age in RSV infection (OR, 1.4; P = 0.004). Outbreaks of hMPV, rather than, RSV infection may have a greater impact on the development of hypoxic respiratory illness in asthmatic children.

A 60-Year-Old Asymptomatic Woman With Pulmonary Lesions and Cervical Lymphadenopathy

A 60-year-old asymptomatic woman was referred to our hospital because of an abnormal chest roentgenogram during a routine medical checkup. The patient had no history of memorable infectious diseases, except a liver abscess caused by Serratia marcescens at age 46 years. Her son was diagnosed with chronic granulomatous disease at the age of 1 year. She had never smoked cigarettes and drank only occasionally.

An atypical case of lymphoproliferative pulmonary involvement in a patient with Sjögren’s syndrome: a case report

BackgroundSjögren’s syndrome is characterized by lymphocytic infiltration of the exocrine glands, together with polyclonal B-cell activation, and lung diseases are well-known complications of the disease. Therefore, in most cases associated with Sjögren’s syndrome, infiltrating lymphocytes in the lung specimen exhibit the features of B-cells. We herein report an atypical case of lymphoproliferative pulmonary involvement in a patient with Sjögren’s syndrome.Case presentationA 46-year-old female was admitted to our hospital because of an abnormal chest roentgenogram finding on a medical checkup. Chest computed tomography showed randomly-distributed micronodules and patchy ground-glass opacities. A surgical biopsied specimen showed an atypical pattern of interstitial pneumonia with numerous lymphoid follicles. Among the infiltrating lymphocytes in the lung, only the monoclonality of the T-cells was proven by a gene rearrangement analysis, but there was no cytological atypicality or genetic disorder revealed by testing the bone marrow aspirate. A diagnosis of Sjögren’s syndrome was made based on the patient’s other symptoms and these negative findings. The patient’s pulmonary lesions have been successfully treated and remission has been maintained for over three years with corticosteroid treatment alone.ConclusionThe present patient was an atypical case of lymphoproliferative pulmonary involvement in a patient with Sjögren’s syndrome. Although monoclonality of the infiltrating T-cells was proven, the clinical course and the findings of the imaging and laboratory examinations were inconsistent with the previously-reported cases of primary pulmonary T-cell lymphoma. This suggests that the monoclonality of lymphocytes does not always define malignancy. The diagnosis of malignant lymphoma or lymphoproliferative diseases should be made clinically, pathologically and cytogenetically to rule out other similar diseases.

Posterior Mediastinal Malignant Lymphoma Mimicking a Neurogenic Tumor

A 59-year-old asymptomatic woman was referred to our hospital for evaluation of an abnormal chest roentgenogram shadow detected on a routine medical checkup. Computed tomography of the chest revealed a 5.1 3.8 cm posterior mediastinal mass in the right thoracic paravertebral region (Fig 1A). F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) showed FDG uptake in the mediastinal tumor (maximum standardized uptake value 4.27). Swollen abdominal paraaortic lymph nodes with FDG uptake (maximum standardized uptake value 7.05) were also detected (Fig 1B, arrowhead). The mediastinal tumor was suspected to be a neurogenic tumor because of its location and imaging findings. The swollen abdominal nodes were independently suspected to be malignant lymphoma. Therefore, video-

Successful Two-Stage Surgical Treatment for Lung Cancer in a Patient with Contralateral Giant Emphysematous Bullae

A 67-year-old man was referred for further evaluation of an abnormal chest roentgenogram. Computed tomography showed a 40 × 30 mm mass in the left upper lobe. A giant bulla occupying about two-thirds of the right thorax was found compressing the adjacent lung parenchyma, shifting the mediastinum to the left. The mass was a primary lung cancer, clinical T2aN0M0, stage IB. Preoperative respiratory function evaluation showed poor pulmonary function, with a forced expiratory volume in 1 second of 1070 ml (29.2% of predicted). Therefore, we first performed giant bullectomy by video-assisted thoracoscopic surgery. At 1 month after this operation, improvement of the forced expiratory volume in 1 second significantly to 2140 ml (80.1% of predicted) was observed. Therefore, we performed resection for the tumor. He was discharged after an uneventful postoperative course, and has remained in good condition for 6 months after the operation.

An unusual presentation of pulmonary cryptococcosis with co-existing disseminated tuberculosis in an AIDS patient

Although cryptococcosis with lung involvement is not rare in patients with HIV, it is rarely considered in the differential diagnosis of an abnormal chest roentgenogram. Pulmonary cryptococcosis with concomitant opportunistic infections is frequently seen among AIDS and its association with tuberculosis (TB) has been previously reported. Untreated pulmonary cryptococcosis in immunocompromised hosts usually becomes disseminated and results in considerable mortality despite antifungal therapy. We report a case of cryptococcosis with pulmonary involvement in a patient with coexisting disseminated TB in HIV infection.

Diagnostic usefulness of transbronchial aspiration and bronchial lavage for pulmonary tuberculosis

Fiberoptic bronchoscopy is a well established methods as a useful tool in the diagnosis of pulmonary tuberculosis with smear negative cases. In order to get the early and definite diagnosis of pulmonary tuberculosis, we performed transbronchial aspiration and bronchial lavage by a fiberoptic bronchoscope in 97 patients. All patients (1) were clinically suspected of having active tuberculosis; (2) showed abnormal chest roentgenogram suggesting tuberculosis; (3) showed negative sputum smears of acid-fast bacilli, or had no sputum. The results of the study were summarized as follows: 1) Final diagnosis of study subjects were 90 patients of active pulmonary tuberculosis, and 7 patients of pulmonary atypical mycobacteriosis. 2) Sputum culture of acid-fast bacilli was positive in 22 out of 90 patients with active pulmonary tuberculosis. 3) Smear and culture examination of acid-fast bacilli of transbronchial aspirates were positive in 9 and 28, respectively out of 90 patients. 4) Smear and culture examination of acid-fast bacilli of bronchial lavage were positive in 12 and 39, respectively out of 90 patients. 5) A rapid and definite diagnosis was made in 16 out of 90 patients by transbronchial aspirates or bronchial lavage. 6) Atypical mycobacteria were detected in 7 out of 97 patients by transbronchial aspirates or bronchial lavage. 7) There were no serious complications such as pneumonia and exacerbation of pulmonary tuberculosis. These results suggested that transbronchial aspiration and bronchial lavage were useful procedures for rapid and definite diagnosis of pulmonary tuberculosis.

A Doughnut in the Heart: Peculiar Finding of a Giant Coronary Artery Aneurysm With Coronary Arteriovenous Fistula

![Figure][1] ![Figure][1] [![Graphic][3] ][3] Coronary Angiography A 23-mm doughnut-shaped aneurysm arising from the conus branch, entering the main pulmonary trunk. A 73-year-old woman was referred to our hospital because of an abnormal chest roentgenogram finding consisting

Meningitis tuberculosa: revisión de 27 años

To analyze the features and outcome of children with tuberculous meningitis (TM) in a tertiary hospital in Madrid, with special emphasis on the possible influence of HIV infection, immigration and withdrawal of the Bacille-Calmette-Guérin (BCG) vaccine in Madrid in 1987. We reviewed the medical records of patients with TM diagnosed over a 27-year period (1977-2003). TM was diagnosed on the basis of compatible cytochemical findings in cerebrospinal fluid (CSF), plus a) isolation of Mycobacterium tuberculosis in CSF or gastric fluid; b) positive Mantoux test, or c) previous contact with active tuberculosis. Twenty-eight cases of TM were diagnosed. There were 24 cases (85 %) in the first 14 years versus only four cases (15 %) in the last 13 years. None of the children was co-infected with HIV. The median age was 3 years and 4 months. Only two of these had received the BCG vaccine. The source of infection was identified in 64 %. At admission, 57 % had nuchal rigidity, 46 % had neurological focality, and 54 % had an abnormal chest roentgenogram. The Mantoux purified protein derivative (PPD) test was positive in 89 % at diagnosis. Zhiel-Nielsen smear in CSF was positive in 3.5 %, and a positive culture from CSF was obtained in 32 %. Computed tomography scan was performed in 22 children and showed hydrocephalus in 90 %. All patients were treated with four drugs, with no significant adverse events. Corticoids (89 %), ventricular-peritoneal shunt (43 %) and antiepileptic drugs (39 %) were widely used as complementary treatments. Mortality was 12 %. Half of the patients had sequels, which were mostly permanent. The most frequent and severe complication was neurodevelopmental delay (21 %). Severe sequels occurred in children with more advanced stages of illness. The frequency of TM has decreased in the last 15 years, despite the emergence of HIV and immigration from countries where tuberculosis is endemic. These data are in agreement with the general reduction of the incidence of TM in our environment. Withdrawal of the BCG vaccine in Madrid in 1987 did not increase cases of TM in our hospital; on the contrary, these have decreased. A considerable percentage of children with advanced stages of TM show severe sequels.

Urinary Tuberculosis: Ten Years' Experience

In this study of 26 patients, clinical features diagnosed as urinary tuberculosis in our nephrology and urology clinics between 1993 and 2002 were investigated retrospectively. Fifteen patients (52%) were male, and mean age was 43.5 (18–71). Twenty percent of the patients were asymptomatic. Frequency-dysuria (46%), flank pain (33%), and macroscopic hematuria (12%) were presenting symptoms. Physical examination was not diagnostically helpful in most patients. Hematuria and/or pyuria were detected in 80% of the patients. Eleven patients had positive urine cultures of Mycobacterium tuberculosis (42%), and 7 patients had positive smears (25%). Definitive diagnosis of urinary tuberculosis was established microbiologically in 15 patients (58%) and histopathologically in 11 patients (42%). Tuberculin skin test was positive in 60% of the patients. Eight patients had an abnormal chest roentgenogram. Hydronephrosis (majority bilateral) in 11 patients (42%), contracted bladder in 9 patients (34.6%), and renal calcification in 6 patients (23%) were detected. Two patients also had genital tuberculosis (epididymoorchitis). Although only medical treatment was applied in 13 patients for 9 months, in the rest of the patients medical therapy plus surgical intervention was carried out. End-stage renal failure developed in one patient who died on hemodialysis. Renal functions had decreased moderately in two other patients. In conclusion, the diagnosis of urinary tuberculosis was able to be established after the obstructive complications and functional losses were developed in a fair number of cases. Surgical treatment was carried out in half the patients. Urinary tuberculosis should be taken into consideration because early diagnosis and treatment is very important for the presenting of irreversible sequelae.

A Case of Methotrexate Induced Pneumonitis in a Patient with Rheumatoid Arthritis

저자들은 급성호흡곤란을 주소로 내원한 류마티스 관절염 환자에서 임상소견과 흉부 방사선소견, 기관지폐포세척액 및 경기관지폐생검을 통해 methotrexate에 의한 간질성 폐렴 1예를 진단하였기에 문헌 고찰과 함께 보고하는 바이다. 【Methotrexate is commonly used in rheumatoid arthritis as an anti-inflammatory agent, but treatment with methotrexate can lead to severe side effects, especially pulmonary complication. Interstitial pneumonitis is one of the most important pulmonary adverse effects of methotrexate and most patient present with a subacute febrile illness and peripheral eosinophilia is seen in about a half of patients. Almost all patients have abnormal chest roentgenograms and bibasilar interstitial infiltration with alveolar pulmonary consolidations is the most characteristic finding. Interstitial inflammation with mononuclear cell infiltration is a characteristic pathologic feature and findings that suggest acute hypersensitivity pneumonitis, such as bronchiolitis, granuloma formation with giant cells, and infiltration with eosinophils are often present. Methotrexate-induced pneumonitis is a potentially life threatening and unpredictable complication but it is difficult to make a definite diagnosis in the absence of high index of clinical suspicion. Early recognition and appropriate management may avoid the serious outcome. Herein we report a case of methotrexate-induced pneumonitis in a patient with rheumatoid arthritis.】

Kaposi's Sarcoma Presenting with Endobronchial Lesions

Kaposi's Sarcoma Presenting with Endobronchial Lesions

A Heart Defect Found Upon Self-Examination in an Asymptomatic Patient

A 32-year-old echocardiographic technician was honing her skills by self-examination when she noted that her right ventricle was dilated. A cardiologist confirmed her finding and noted a left-to-right shunt across a 1-cm defect in the fossa ovalis region of the atrial septum. The patient was entirely asymptomatic and regularly engaged in an aerobic exercise program. Physical examination revealed mild pectus excavatum. The right ventricle was not palpable. The a wave in the jugular venous pulse was larger than the v wave. The second heart sound was of normal intensity, was persistently split, and moved physiologically with respiration. The only definite auscultatory abnormality was a third heart sound followed by a short diastolic rumble heard at the lower left sternal border. A chest roentgenogram showed mild enlargement of the cardiac silhouette and minimal prominence of the pulmonary trunk and vasculature. A normal electrocardiogram was recorded. The normal electrocardiogram, the inequality of the a and v waves in the jugular pulse, the respiratory movement of the second heart sound, the absence of a systolic ejection murmur, and the size of the defect measured echocardiographically all suggested that the defect was restrictive and the left-to-right shunt smaller than usual. On the other hand, the third heart sound and short diastolic rumble, the minor abnormalities on chest roentgenogram, and the dilated right ventricle on echocardiography indicated that the shunt was hemodynamically important, and operative closure was recommended. After collecting second opinions for over a year, the patient agreed, and the defect was closed by primary suture. This is the second of our patients whose fossa ovalis–type atrial septal defect was discovered in such a serendipitous fashion. The first was a 22-year-old echocardiographic repairman seen 28 years ago. When he finished repairing the echocardiograph, he was asked to volunteer for an echocardiogram to be sure the machine was working properly, and the defect was found. He also underwent primary suture closure despite being asymptomatic. Until the echocardiograph came into daily use in cardiologic practice, atrial septal defects were diagnosed on the basis of symptoms, sometimes subtle but unmistakable physical findings, distinctly abnormal chest roentgenograms, and abnormal electrocardiograms that typically showed incomplete right bundle-branch block, often with right axis deviation. Because symptoms developed in 70% of such patients by age 40 and in virtually all of them by age 60 (1), and because operative closure carried a low risk and improved prognosis when performed early (2–5), closure of fossa ovalis–type atrial septal defects was uniformly recommended in the absence of severe pulmonary arterial disease. Does this conventional wisdom apply to patients, such as ours, whose defects are smaller and probably would not have been discovered except for serendipitous echocardiography? Opinion is divided (6). The patient herself has had second thoughts post-operatively because of several bouts of postpericardiotomy syndrome, a common problem after operative closure of atrial septal defects. She has now been well for more than 3 years, and those doubts are receding. Our own view is that a left-to-right shunt large enough to cause right ventricular enlargement should be closed, even in the absence of symptoms. As catheter-delivered devices to close holes in the atrial septum are perfected (7), perhaps even smaller defects will be closed routinely, regardless of symptoms.

FDG-PET in the diagnosis of pulmonary lesions

To evaluate the ability of ¹⁸FDG-PET to differentiate benign from malignant pulmonary lesions. Twenty-seven patients who had abnormal chest roentgenograms underwent ¹⁸FDG-PET. PET scan interpretation was based on visual qualitative analysis of images. Ratio of ¹⁸FDG uptake in the lesion and normal lung tissue assessed visually was used as criteria for differentiation between benign and malignant lesions. Malignant lesions should have lesion/lung ratio larger than 1. 5, while benign lesions should have ratio less than 1. 5. PET results were compared with pathological results, which were the gold standard. Out of the 27 pulmonary lesions, there were 21 malignant ( 8 cases of adenocarcinoma, 7 squamous cell carcinoma, 2 small cell lung cancer, 1 large cell carcinoma, 3 metastatic carcinoma) and 6 benign lesions. There were 20 cases whose lesion/lung ratio was larger than 1. 5 and 7 cases less than 1. 5, with an accuracy, sensitivity, specificity, positive predictive value and negative predictive value of 96. 3%, 95. 2%, 100. 0%, 100. 0%and 85. 7% respectively, for detecting malignant pulmonary lesions. ¹⁸FDG-PET imaging accurately differentiates malignant from benign pulmonary lesions. PET can be a useful noninvasive test to evaluate indeterminate pulmonary lesions, which will provide us with more accurate and valuable diagnostic information.

Thoracic rupture of hepatic hydatidosis (123 cases)

Background. Hydatid disease is frequently endemic in countries with poor environmental sanitation and in geographic areas where interaction between humans and animals is common. Pulmonary complications result from the proximity of hydatid cysts in the liver and the diaphragm. Methods. The medical records of 123 patients, with established hydatid disease manifesting abnormal chest roentgenograms, were retrospectively analyzed for the period January 1990 to December 1999. Results. Chest roentgenogram and abdominal ultrasound provided a correct preoperative diagnosis in 108 patients (87.8%). Expectoration of bile, demonstration of fistula by ultrasound, expectoration of cyst contents, and additional ultrasound or imaging findings were the criteria used to establish the preoperative diagnosis. The remaining 15 cases were confirmed at operation. Men outnumbered women nearly 3:1. Mean age was 36.2 years. Pulmonary resection was performed in 67 cases. Sixty-eight patients presented with a bronchobiliary fistula (55.3%). Morbidity rate was 14.6% and mortality rate was 8.9%. Conclusions. Thoracotomy offers adequate simultaneous access to both the chest and hepatic lesions with acceptable morbidity and mortality. Endoscopic sphincterotomy undertaken preoperatively is useful in reducing biliary complications.

Panniculitis in tuberculosis: a clinicopathologic study of nodular panniculitis associated with tuberculosis.

Certain types of panniculitis, erythema induratum of Bazin and erythema nodosum, have been well documented as tuberculids. Many histopathologic diagnoses of panniculitis have been reported in tuberculosis patients. This study investigates the correlation between underlying tuberculosis and clinicopathologic findings of panniculitis. We retrospectively reviewed the clinical files of histologic-proven panniculitis cases at the Dermatologic Clinic, Siriraj Hospital from January 1992 to December 1995; only cases with active tuberculous foci were analyzed. The incidence of panniculitis caused by tuberculosis was 8.2%. The ratio of men to women was 1:1. The mean age of onset was 35.3 years. The average duration of the nodules was 35.5 days. There was a history of contact tuberculosis in 16.6%. Constitutional symptoms and a strongly positive purified protein derivative (PPD) reaction were found in 66.6%. Chest roentgenograms were abnormal in 83.3%. The erythrocyte sedimentation rate was elevated in all tested cases. The histopathologic diagnoses were nodular vasculitis (33.3%), erythema nodosum (50%), and cutaneous periarteritis nodosa (16.4%). The panniculitis lesion responded to standard antituberculous regimens in 4.6 weeks, on average, with residual hyperpigmentation. In panniculitis patients, clues for the investigation of tuberculosis included constitutional symptoms, elevated erythrocyte sedimentation rate, and abnormal chest roentgenograms. Histopathologic changes of panniculitis did not seem to correlate with underlying tuberculosis. The clinician should be aware of the tuberculosis, however, and should carefully search for active foci in all panniculitis patients.

Occult lung cancer beyond bronchoscopic visibility in sputum-cytology positive patients

Sputum cytology is useful for screening and diagnosis of centrally located lung cancer in Japan. On the other hand, cancer beyond the range of bronchoscopic visibility in X-ray negative patients can be detected only with difficulty. Of 265 patients detected by sputum cytology in mass screening, 85 had an abnormal chest roentgenogram and the remaining 180 were roentgenographically occult. A total of 200 roentgenographically occult squamous cell carcinoma lesions were detected in the above 180 patients. A total of 45 of the 200 lesions were bronchoscopically occult. Twenty-two of the above 45 lesions were beyond the range of bronchoscopic visibility with a standard bronchoscope. The data obtained show that a sputum cytology positive, X-ray negative squamous cell carcinoma may lie outside the reach of a flexible bronchoscope. Thus, when it is difficult to localize a cancer, brushing of the peripheral bronchi beyond bronchoscopic visibility and chest computed tomography should be performed.

Utility of helical 3D-CT in the diagnosis of the aberrant artery of pulmonary sequestration

Four patients with abnormal chest roentgenograms were evaluated and were proven intralobar pulmonary sequestration (IPS) at surgery. A 7-year-old boy and a 26-year old man had left lower IPS. Helical 3D-CT demonstrated the aberrant artery arising from the descending thoracic aorta and the draining pulmonary veins. They underwent left lower lobectomy. A 23-year-old man and a 35-year-old woman had right lower IPS. Helical 3D-CT demonstrated the aberrant artery arising from the abdominal aorta and the draining pulmonary veins. They were treated by left lower partial lobectomy. Helical 3D-CT is noninvasive, and provides accurate, three-dimensional information of the aberrant vascular supply of the pulmonary sequestration, which closely simulates the angiographic and surgical findings. Helical 3D-CT can replace angiography in the preoperative diagnosis of the pulmonary sequestration.

A Case of Congenital Bronchial Atresia with Mucocele

Bronchial atresia is a rare congenital anomaly characterized by a bronchocele resulting from a mucus-filled, blindly-terminating segmental or lobal bronchus, and hyperinflation of the obstructed segment of lung. Characteristically, the patient is young and asymptomatic but has an abnormal chest roentgenogram. The only physical finding may be decreased breathing sounds over the affected parenchyma. We experienced a case of bronchial atresia with mucocele in adult So we report it with a review of the literature.

Traumatic Thoracic Aortic Rupture in the Pediatric Patient

Traumatic thoracic aortic rupture is a rare injury in the pediatric patient. Experiences with thoracic aortic rupture in patients less than 17 years of age are needed to help identify factors that can influence injury occurrence, diagnosis, management, and outcome. Between July 1989 and December 1995, 6 children were treated operatively for thoracic aortic rupture from blunt trauma at a level I pediatric trauma center. The average age was 13.2 years (range, 8 to 16 years). There were 4 females and 2 males. There were 5 motor vehicle accidents and 1 bicycle accident. Aortic injury was suspected based on the mechanism of injury and abnormal chest roentgenogram results, and was confirmed by aortography (3 cases) or chest computed tomography (2) and transesophageal echocardiography (3). Life-threatening central nervous system or gastrointestinal injuries were evaluated or treated first. Operative repair of the thoracic aorta was performed by cardiopulmonary bypass (2 patients) and clamp and sew technique (4). Aortic ruptures were complete transections at the ligamentum arteriosum in 5 of 6 (83%); the other case was a cervical arch pseudoaneurysm. Associated injuries included pulmonary contusion (100%), pelvic/long bone fractures (50%), visceral laceration/perforation (50%), central nervous system (33%), paraplegia (17%), and myocardial contusion (17%). There were no rib fractures. Four of 5 patients (80%) were not wearing seat belts, and 2 of these were ejected. The average time from injury to the operating room was 17.6 hours (range, 5 to 48 hours); the time from diagnosis to the operating room exceeded 5 hours with aortography and was less than 3 hours with chest computed tomography and transesophageal echocardiography. Each diagnostic modality accurately identified an aortic injury. The average time for cardiopulmonary bypass and for clamp and sew was 52 minutes (range, 49 to 55 minutes) and 34 minutes (range, 16 to 45 minutes), respectively. One patient with preoperative paraplegia regained partial function; there were no other patients with paraplegia. There were no deaths. All patients are alive 2 months to 7 years after repair. The multiply injured child with severe blunt trauma and an abnormal chest roentgenogram requires a search for aortic injury. We believe the most effective algorithm to follow for the diagnosis of traumatic thoracic aortic rupture in the child involves selective performance of chest computed tomography and transesophageal echocardiography. Our experience suggests that the mechanism of injury, the duration to diagnosis of an aortic injury, and failure to use seat belts may contribute to morbidity. A high index of suspicion and a systematic approach to the diagnosis and to the management strategy for injuries to the thoracic aorta can contribute to a good outcome in those few children who survive the injury.