imaging aorta?

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I've got a 28 male in the department - came off a bicycle at 40 kph (25 
mph).  Injuries - fractures of left 1st and 2nd ribs, comminuted fracture 
outer 1/3 left clavicle.  No other injuries.  Haemodynamically stable and 
peripheral pulses OK.

CXR (erect) shows pleural apical capping and possible widened mediastinum.  
Films not well centred but I can't see depression of L mainstem bronchus or 
mediastinal shift.

With this complex of clinical and radiological findings I'm pushing for 
further imaging - in particular arch aortogram.  Surgeons are not interested 
(but they might eventually do a CT).

Am I over calling this one?.  I've attached a CXR - it's a photo from a 
viewing box so I apologise for the quality.

John

Dr John L Holmes
Director Emergency Medicine
Mater Adult Hospital, Brisbane, Australia

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