The American surgeon
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The indications for thoracic aortography in the blunt chest trauma patient remain controversial. Clinical and radiographic findings in 102 patients seen at a Level I Trauma Center over a five-year period were reviewed to evaluate criteria predictive of major thoracic vascular injury. Five patients had positive aortograms. ⋯ A blinded review of admitting chest radiographs for five major findings (widened mediastinum, aortic arch abnormalities, aortopulmonary window opacification, left apical capping, and right apical capping) revealed a significant difference between patients with and without aortic injury (0.98 +/- 1.24 findings in the negative aortogram group and 3.00 +/- 0.71 findings in the positive aortogram group) (P less than 0.001). All patients with aortic rupture had at least two major positive findings on admitting chest radiographs. Admission chest x-ray evidence of at least one major abnormality is a safe method of screening blunt chest trauma patients for thoracic aortography.