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"AORTIC TRANSECTION"

“ Occurs following major blunt trauma, 90% in the proximal descending aorta at the level of the isthmus ( mobile aortic arch moves against ...

Occurs following major blunt trauma, 90% in the proximal descending aorta at the level of the isthmus (mobile aortic arch moves against the fixed descending aorta at the level of the ligamentum arteriosum). The diaphragmatic hiatus and aortic root are other risk areas.
PLAIN FILM 

•  Widened mediastinum (over 8 cm above the level of the carina and more than 25% of the width of the chest) or indistinct arch contour.
•  Left apical pleural cap is classic, due to pleural haematoma.
•  Look for rightward deviation of the trachea and depression of the left main bronchus.

Transection of the aorta. Chest x-ray demonstrating widening of the mediastinum, a left apical pleural cap with slight deviation of the trachea to the right. There is also a fracture of the right second rib in keeping with high-energy trauma.
Transection of the aorta. CT demonstrating a transection of the aorta (white arrow) with mediastinal haematoma and pleural haematoma (red arrow), which creates the apical pleural cap on the chest x-ray.