This patient was involved in a high speed motor vehicle accident. There is a laceration of the proximal descending thoracic aorta (indicated by an intimal flap), periaortic haematoma and bilateral haemothoraces.
Most blunt aortic injury occurs in the thoracic aorta and 90% occur at the site of attachment of the ligamentum arteriosum. The findings on chest x-ray are that of mediastinal haematoma which has a high sensitivity but low specificity because most mediastinal haematoma in trauma is due to other causes. CT angiography (CTA) has a close to 100% sensitivity and specificity and is the investigation of choice because it delineates the aortic injury itself. Conventional angiography is rarely used due to widespread availability of high quality CTA and carries risk of dissection or rupture of the aorta by the guidewire or catheter.

Aortic injury is a surgical emergency and is usually treated with an aortic stent graft, or sometimes with open repair.
Credit: Dr Donna D’Souza