Traumatic rupture of the thoracic aorta should be suspected in all patients who have a history of severe deceleration injury or blunt chest trauma. A good upright (except in fractured spine) and supine x-rays of the chest using the correct technique are important. Mediastinum widening (subjective impression or mediastinum to chest ratio of 1:4) and/or loss of aortic knob contour or disfigurement should lend more support to a thoracic aortogram. The other findings discussed are rarely found alone and are almost always associated with multiple findings. The only way to diagnose a ruptured thoracic aorta is to do a comprehensive aortogram with biplanar films and always to have a high index of suspicion.
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