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Updated: Aug 23, 2026

An Approach to Point-Of-Care Ultrasound Evaluation of the Abdominal Aorta
Published on: September 8, 2023
Left mediastinal width and mediastinal width ratio are better radiographic criteria than general mediastinal width
Yon-Cheong Wong1, Chip-Jin Ng, Li-Jen Wang
1Second Division, Department of Radiology, Chang Gung Memorial Hospital, Chang Gung University, Gueishan, Taoyuan, Taiwan. ycwong@cgmh.org.tw
Background:
General mediastinal width, left mediastinal width, and mediastinal width ratio were compared as radiographic predictors of aortic injury.
Methods:
A retrospective study investigated the chest radiographs of 51 patients admitted to a level 1 trauma center during a 6-year period for a thorough survey of aortic injury. Mediastinal width (MW >/= 8 cm), left mediastinal width (LMW >/= 6 cm), mediastinal width ratio (MWR >/= 0.60), and a combination of LMW and MWR were compared as predictors of aortic injury. The cutoff points were predetermined by receiver-operator-curve to accommodate 100% sensitivity for each criterion.
Results:
Of the 51 patients, 21 had aortic injuries and 30 had normal imaging studies. All criteria had 100% negative predictive value. The specificities and positive predictive values, respectively, were 13.3% and 44.7% (MW), 40.0% and 53.8% (LMW), 43.3% and 55.3% (MWR), and 66.7% and 67.7% (combined LMW and MWR). The positive likelihood ratio of aortic injury was 3.00 when LMW was 6 cm or more and MWR was 0.60 or more.
Conclusions:
Both an LMW of 6 cm or more and an MWR of 0.60 or more are better radiographic criteria than an MW of 8 cm or more for predicting blunt aortic injury. Trauma patients with positive test results based on the combined LMW and MWR criteria should proceed immediately to aortography or helical computed tomography.
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