Plain-film criteria for excluding aortic rupture in blunt chest trauma.

Emergency room supine chest films of 86 consecutive patients with blunt chest trauma and possible aortic rupture were reviewed. Sixteen radiographic signs were analyzed independently and in combination. Only two signs associated with aortic rupture were statistically significant: deviation of the nasogastric tube to the right at the T4 level and depression of the left main-stem bronchus below 40 degrees from the horizontal. False positives and false negatives occurred with each individual radiographic sign. However, if the aortic knob and contour appeared normal and the trachea and nasogastric tube were not deviated, no case was found of aortic rupture in 4 consecutive years of experience. These four signs can be used to exclude the diagnosis of aortic rupture in patients with blunt chest trauma.