Here is the submitted question: “A man involved in an MVA with multiple rib fractures, bruising over his chest and blah blah blah.
CXR shows widened mediastinum, tracheal deviation, bronchial displacement and loss of the aortic knob.
They ask the next best step in the management of this patient. The choices are Angiography of the chest, CT Chest, MRI Chest, TEE and urgent surgical consult.
The answer that they give is CT CHest.
I understand that CT would best define what we’re looking at, but USMLE World and one of my review books says that TEE is sensitive and specific and can be used to pick up an aortic rupture. Wouldn’t that be the more logical test in this situation given the time frame
The TEE, CT angiogram and MRA are all equally sensitive in the detection of aortic aneurysm.
With multiple trauma, however, the Chest CT is better to look at all the detail to be found in the chest. The problem with this question is NOT the testing issue, it is the fact that with such severe clinical presentation , you can easily mke the case for going straight to the Operating room.