Step 2 CK First Aid Rapid Practice Test

Mediastinal widening on a chest radiograph is the most consistent clue for acute aortic disruption after blunt chest trauma. When the aorta is injured, blood can accumulate in the mediastinum and blur the aortic contour, sometimes with a left apical cap or deviation of mediastinal structures. Seeing a widened mediastinum together with these other subtle signs raises strong concern for aortic injury and prompts urgent advanced imaging, such as CT angiography.

A normal mediastinal contour makes acute aortic disruption unlikely. A rib fracture seen without mediastinal signs doesn’t specifically point to aortic injury, and pneumonia is unrelated to acute aortic disruption.