Cervical prevertebral soft-tissue measurements and chest radiographic findings in acute traumatic aortic injury

Acute traumatic aortic injury (ATAI) results in several characteristic chest radiographic findings, most notably mediastinal widening. This study was based on the hypothesis that blood or fluid in the widened mediastinum might track up into the neck and be detected on lateral cervical radiographs. In a blinded, retrospective, case-control review of radiology files, 13 consecutive adult cases of ATAI were identified and compared with 19 cases of negative aortography (NAO) and 18 multiple trauma victims (MT) without aortography. Cases with inadequate cervical films or cervical injury were excluded. Measurements included the cervical soft-tissue (ST) width at the third (C3) and sixth (C6) cervical vertebrae, mediastinal width, mediastinal-chest width ratio, and the presence of several characteristic chest radiograph findings of ATAI. The C3 ST measurements averaged 9.1 ± 2.8 mm, 8.5 ± 2.7 mm, and 6.9 ± 2.2 mm for the ATAI, NAO, and MT groups, respectively. The C6 ST measurements averaged 19.2 ± 4.5 mm, 18.6 ± 3.9, and 16.5 ± 3.8 mm for the ATAI, NAO, and MT groups, respectively. These cervical ST values were not significantly different between groups at either C3 (P = .188) or C6 (P = .148). The incidence of abnormal ST swelling of>7 mm at C3 was 38%, 53%, and 33% for the ATAI, NAO, and MT groups, respectively. The incidence of abnormal ST swelling of>20 mm at C6 was 54%, 42%, and 11% for the ATAI, NAO, and MT groups, respectively. Cervical ST measurements at C3 or at C6 did not correlate with mediastinal-chest width ratios. Mediastinal widening, aortopulmonic window opacification, and blurring of the aortic knob were the most sensitive chest radiography findings in ATAI, although each of these lacked useful specificity and accuracy. Cervical ST swelling is not a useful marker for ATAI.