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Twenty-four patients with widened mediastinum were studied, of whom 7 had ruptured thoracic aorta, 8 had mediastinal hematoma, 6 had paravertebral hematoma, and 3, due to faulty diagnostic technique, appeared to have widened mediastinum. Nine patients underwent operation with 5 surviving; 3 had acute aortic rupture, 2 had delayed aortic aneurysm, 1 had avulsion of retrosternal tissues, 2 had ruptured intercostal and mammary vessels, and 1 had an atheromatous plaque mimicking aortic rupture. Wide mediastinum is caused by aortic rupture or mediastinal hematoma, but poor radiographic technique can lead to a mistaken diagnosis. The plain chest film and the aortogram are essential for the proper diagnosis of widened mediastinum in trauma.

An initial report on the clinical, radiological, and pathological aspects of the lung changes encountered in certain men employed in the manufacture of alumina abrasives has already been published (1). A further report on the chemical aspect of the disease has been read but as yet is unpublished (2). Twelve months have elapsed since the first report was read and during this interval we have had a further period to study in greater detail the symptomatology and clinical features of the disease, as well as serial radiographs. Our initial report presented two groups of cases, well established and early. In the former group there were 23 cases, whereas there are now 34. In the early group there were 12; there are now 38. The classification of well established disease is based on clinical and radiological evidence. All patients with symptoms have changes of moderate to extreme degree demonstrable by x-rays. Others may have few symptoms but the x-ray picture shows a widened mediastinum or marked diaphragmatic a...

Twenty-four patients with deceleration trauma and widened mediastinums have been studied for aortic laceration. Eight had lacerations. Analysis of the chest films demonstrates that the findings of aortic laceration are those of mediastinal bleeding and are nonspecific. While deceleration trauma appears to be causative, a widened mediastinum with such trauma is not diagnostic of aortic laceration. Upright films often cannot be obtained and are not necessary. Serial chest films are contraindicated. Aortography is the definitive technique and should be performed if clinical suspicion of aortic laceration exists.Laceration of the thoracic aorta caused by rapid decleration injury is a surgical emergency. Less than 20% of these patients reach the emergency room alive and, of these, 90% will exsanguinate within four weeks, 25% within 24 hours.1Therefore prompt diagnosis and surgery are imperative. The chest film findings of aortic laceration are nonspecific since any mediastinal bleeding can give the same radiographic appearance. Aortography must be performed to confirm this diagnosis. We have recently seen 24 patients with severe decelera tion injuries all of whom had mediastinal abnormalities suggestive of aortic laceration. Eight actually had lacerations and these cases form the basis for this report.

Diagnosis: Traumatic aortic rupture. The chest roentgenogram on admission (Fig 1) shows enlargement of the aortic knob, widened mediastinum, and density along the descending aorta. There is a small pneumothorax on the right and bilateral juxtahilar alveolar infiltration characteristic of pulmonary contusion. A chest tube was inserted into the right pleural cavity. After this, a thoracic aortogram was performed through a transfemoral approach (Fig 2). The aortogram shows an irregularity of the aortic margin just beyond the left subclavian artery, representing the site of aortic tear. Immediately distal to this, an elongated false aneurysm filled with contrast medium terminates inferiorly where the aorta resumes its normal caliber. There is a residual right pneumothorax and fluid in the left pleura, probably blood. At operation, a complete tear of the aorta was found, with almost 3 cm of separation between the torn ends. The false aneurysm was walled off by organized blood