Superior mediastinal widening from spine fractures mimicking aortic rupture on chest radiographs

Mediastinal widening on chest radiographs associated with lower cervical and upper thoracic spine fractures can mimic the radiographic findings of aortic rupture. Frontal chest radiographs from 54 patients with traumatic fractures of at least one vertebral body from C6 to T8 were examined for signs suggestive of aortic rupture. These signs included (1) mediastinal width equal to or greater than 8 cm; (2) presence of a left apical cap; (3) a right paratracheal stripe of 5 mm or more; and (4) deviation of the nasogastric tube, when present, to the right of the T4 spinous process. Thirty-seven patients (69%) had radiographic signs suggestive of aortic rupture on the initial anteroposterior chest film. The single patient in this group who actually had an aortic rupture died in the emergency department shortly after admission. The spine fracture could be identified on the initial chest radiograph in 19 (51%) of the 37 patients. These results show that a widened mediastinum on chest radiographs after trauma is not a specific finding of aortic rupture. In these cases, the upper thoracic spine should be examined closely on the initial frontal chest radiograph for evidence of fracture. If a fracture of the upper thoracic spine is identified, an aortic rupture is unlikely in the absence of clinical signs and symptoms supporting this diagnosis.