Evaluation of Mediastinal Width in Supine Chest Radiography and Computed Tomography of the Patients Referred to Shahid Rajaee Trauma Center, Shiraz, Spring 2014

Mediastinal widening is a serious complication in patients with chest trauma. The gold standard method for diagnosis of this condition is chest Computed Tomography (CT) scan which is not applicable in many cases due to the high dose of radiation, high-cost, and emergency conditions. One of the most practicable and cost-effective diagnostic methods is supine Chest X-Ray (CXR). This study aimed to assess the diagnostic value of supine chest radiography for mediastinal widening by comparing the mediastinal width in supine CXR and chest CT scan (gold standard method) in patients with blunt chest trauma.
In this prospective non-interventional study, multi-detector chest CT scan was performed for patients with blunt chest trauma who had abnormal supine CXR or suspicious clinical findings. Mediastinal width was compared in CXR and CT scan in each patient for determination of accuracy of supine CXR in diagnosis of mediastinal widening.
The sensitivity, specificity, positive predictive value, and negative predictive value of supine chest radiography were 16.6%, 97.5%, 57.1%, and 85.5%, respectively.
Considering the high positive predictive value of supine CXR, it can be concluded that normal supine CXR could be highly suggestive of exclusion of mediastinal widening. CT scan remains the gold standard diagnostic method in patients with high clinical suspicion of mediastinal widening.