A 66-year-old man is brought for evaluation after sustaining a fall. He was working on a telephone pole, approximately 50 feet above the ground, when he slipped and fell; he was able to break his fall somewhat by grabbing the pole, but still fell about 10 to 15 feet. He is complaining primarily of left hip pain.
His medical history is unremarkable except for mild hypertension. On arrival at your facility, his vital signs include a blood pressure of 101/57 mm/Hg, heart rate, 71 beats/min, and respiratory rate, 18 breaths/min.
Physical examination shows obvious left hip deformity but is otherwise unremarkable. Chest radiograph is shown.
Answer
The radiograph shows no acute abnormalities. Of concern, though, is the presence of a widened mediastinum, possibly suggestive of mediastinal or great vessel injury. Subsequent CT of the chest did in fact demonstrate an injury to the aorta, which required urgent surgical repair.
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