Chest Radiographs of Limited Utility in the Diagnosis of Blunt Traumatic Aortic Laceration

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Abstract
The radiographic diagnosis of blunt traumatic aortic laceration (BTAL) remains problematic. We reviewed our experience with chest radiographic signs of BTAL at a single trauma center. The chest radiographs of 188 consecutive blunt trauma patients with suspected BTAL who underwent portable chest radiography and aortography were retrospectively reviewed by a thoracic radiologist. The presence or absence of 15 radiographic findings were recorded, and the sensitivity and specificity of individual radiographic signs and combinations of signs were determined. There were 10 patients with BTAL. Although three signs showed greater than 90% sensitivity for BTAL, these signs showed low specificity, and no significant improvement in overall accuracy was achieved by combining radiographic findings. The experience at our institution suggests that chest radiographs have limited utility in the accurate diagnosis of blunt traumatic aortic laceration. Cross-sectional imaging techniques will likely become the preferred imaging procedures for evaluating patients with suspected BTAL.