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Surgical Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Perform a CXR and look for the following signs of aortic rupture: Widened mediastinum (≥8 cm on a 1 m supine anteroposterior X-ray): 10% of these patients will have a contained aortic rupture confirmedother causes of a widened mediastinum include a mediastinal haematoma from sternal fracture, lower cervical or thoracic spine fracture, oesophageal injury, local venous oozing and projection artefact.Blurred aortic outline with obliteration of the aortic knuckle.Left apical cap of fluid in the pleural space and a left haemothorax.Depressed left main stem bronchus.Displacement of the trachea to the right.Displacement of a nasogastric tube in the oesophagus to the right.
Pre-Hospital and Emergency Trauma Care
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Aortic transection is usually diagnosed with a widened mediastinum and confirmed with an arteriogram or a CT scan (see also Chapter 8). Once the diagnosis has been made, it is useful to maintain control of hypotension in the 100 mm Hg range so as not to precipitate free rupture from the transection, until stenting or operative repair can take place.
Out-of-hours and emergency palliative care
Published in Rodger Charlton, Primary Palliative Care, 2018
Chest X-ray will show a widened mediastinum, often with other features of lung cancer. CT scanning will demonstrate a compressed superior vena cava, and occasionally the presence of clot or tumour within it. For patients in whom SVCO is the presenting complaint, bronchoscopy may be performed to secure a tissue diagnosis.
Double superior vena cava: presentation of two cases and review of the literature
Published in Acta Chirurgica Belgica, 2019
Christos Farazi-Chongouki, Ioannis Dalianoudis, Anestis Ninos, Pantelis Diamantopoulos, Dimitrios Filippou, Stefanos Pierrakakis, Panagiotis Skandalakis
Duplication of SVC is a rather rare entity but extremely important to the awareness of any physician. It can be suspected in several cases when imaging findings contradict the clinical presentation of the patient. Thus, in asymptomatic patients, a widened mediastinum, a dilated coronary sinus or a misplacement of a left internal jugular or subclavian venous catheter in the X-ray, may raise the suspicion of the presence of a left superior vena cava. In that case, there might be technical difficulty in placement of a catheter from the left side of the patient. Further investigation with CTA imaging and echocardiography is essential for diagnosis.