Nasogastric tube displacement in acute traumatic rupture of the thoracic aorta: a postmortem study

Acute traumatic rupture of the thoracic aorta is an often fatal deceleration injury with only 15%--20% of victims surviving to receive emergency treatment. Numerous chest radiographic findings associated with this injury have been reported, but all are nonspecific. Nasogastric tube deviation to the right has been recently described in two series as a more sensitive and specific sign of aortic rupture, said to be present in 92.8% with rupture and in none with normal thoracic aortas. In this study of eight victims of fatal motor vehicle accidents with documented aortic rupture, five (62.5%) had nasogastric tube deviation to the right and three (37.5%) had deviation to the left. This supports other reported clinical experience suggesting that rightward nasogastric tube deviation in only 60%--70% sensitive for aortic rupture. Thus, absence of nasogastric tube deviation to the right does not exclude the diagnosis of aortic rupture, and decision-making regarding aortography must be based on other clinical and radiologic criteria.