Summary of tests for blunt aortic injury

Diagnostic tests for aortic rupture
Plain radiograph	Upright preferable; sensitivity of supine unclear Normal PA radiograph has high negative predictive value; good test for patients with low to moderate suspicion If high clinical suspicion, or abnormal radiograph, further testing required
Chest CT scan	Test of choice Highly sensitive and specific Requires IV contrast Can usually proceed directly to OR with a positive CT Equivocal studies are rare but necessitate repeat CT (CT angiography), transesophageal echocardiography, or aortography
Aortography	Highly sensitive and specific Mainly used for equivocal CT scans Rarely adds value in the setting of a diagnostic CT and delays potentially lifesaving operative intervention
Transesophageal echocardiography	Highly accurate Can be performed at bedside, in OR, or in patients who cannot tolerate contrast Limited in proximal ruptures but overall an excellent test when CT is unavailable or contraindicated

PA: posteroanterior; IV: intravenous; OR: operating room; CT: computed tomography.

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