A male patient is admitted following a fall from height. On arrival his Glasgow Coma Scale score is 5/15 and he is therefore intubated. During primary resuscitation a chest film is taken which shows a widened mediastinum and right-sided detion of the trachea. The diagnosis is

Aoic rupture -Aoic rupture is a common cause of sudden death following sudden-deceleration injuries occurring in traffic collisions or after falls from height. -The point of disruption in the wall of the aoa is at the ligamentum aeriosum, across which the aoa may kink or twist, causing dissection or rupture. - Rupture into the left side of the chest is nearly universally fatal, unless it occurs in the emergency depament itself. In those who survive, the haematoma is retained either within the adventitia or within the mediastinum. -Features on a chest radiograph include the following: Widening of the mediastinum Loss of the aoic knuckle Detion of the trachea to the right Obliteration of the space between the aoa and pulmonary aery (the AP window) Depression of the left main bronchus Left-sided haemothorax