Can a normal chest radiograph rule out an aortic injury?
The utility of a negative chest x-ray remains controversial. A truly normal PA chest radiograph has a very high negative predictive value for aortic injury (approximately 99%). Some signs, however, are relatively obscure or occult and may be missed on the initial interpretation. Other injuries may make a PA chest radiograph difficult or imprudent to obtain. Therefore, when the suspicion for aortic rupture remains high due to a high-speed or significant deceleration injury, a normal chest x-ray warrants further diagnostic studies. Certainly any finding on the x-ray suggesting possible aortic rupture, no matter how nebulous, requires further evaluation for this potentially devastating injury. Can computed tomography (CT) rule out aortic injuries? Chest CT is considered the standard diagnostic test for suspected aortic injury because it is widely available and has extremely high sensitivity and specificity. In most cases, a negative chest CT using intravenous (IV) contrast can exclude an
