Interesting case of traumatic paediatric chest pain: don't forget the vessels.

A male adolescent was a restrained passenger in a high-speed road traffic collision. At the scene he was noted to be hypotensive and received one unit of blood. In the emergency department, he presented with mild chest pain. He had a normal chest examination. A 20 mm Hg blood pressure difference was found between his right and left arms. His CT chest is displayed in figure 1. Figure 1 CT chest with contrast, axial 3 mm slice taken just below the level of the subclavian artery origin. 1. What is the most likely cause of the CT appearance identified by arrow ‘C’? 1. Pneumothorax 2. Haemothorax 3. Empyema 4. Pulmonary contusion 2. What does the arrow ‘B’ show? 1. Aortic dissection 2. Aortic transection 3. Normal anatomy 4. Cardiac tamponade 3. How would you manage this patient acutely? 4. When would you decide to organise a CT chest …