Mediastinal widening associated with fractures of the upper thoracic spine

Widening of the mediastinum, when seen on radiographs of the chest in victims of trauma, is usually attributed to injury to the aorta. An aortic injury, when not lethal, often causes paraparesis or paraplegia due to ischemia of the spinal cord. A fracture of the upper thoracic spine can produce similar clinical and radiographic findings. The cases of three patients who had those findings are presented; in all three, the differential diagnosis between the vascular and skeletal injuries was difficult. Fracture of the thoracic spine should be included in the differential diagnosis whenever mediastinal widening is seen on radiographs.