The Annals of Thoracic Surgery, Vol 35, 450-454, Copyright © 1983 by The Society of Thoracic Surgeons
Upper rib fractures and mediastinal widening: indications for aortography
R Kirshner, S Seltzer, C D'Orsi and JA DeWeese
Survival of patients with posttraumatic thoracic aortic rupture depends on
early diagnosis. It is frequently stated that fracture of the first or
second ribs and mediastinal widening are findings suggestive of thoracic
aortic rupture. We found that the probability of sustaining thoracic aortic
rupture is the same for patients with upper rib fractures as for those with
other rib fractures (1/64 versus 5/149; p = 0.85). Also, our data fail to
show a statistical difference in the incidence of thoracic aortic rupture
associated with upper (first and second) rib fractures compared with no rib
fracture at all (1/64 versus 9/304; p = 0.85). Thus, patients with thoracic
aortic rupture are not more likely to have rib fractures (7/21 versus
14/21; p = 0.15), and if a rib fracture is present, the probability of it
being at the upper level is the same as that for a fracture at any other
level (1/7 versus 6/7; p = 0.06). Ratios of mediastinal width to chest
width were used as a measure of mediastinal widening, and were found to be
an accurate predictor of thoracic aortic rupture. Ratios greater than 0.28
at the aortic knob were 100% specific and 85% sensitive for this condition.
