Widening of the mediastinum, when seen on radiographs of the chest in
victims of trauma, is usually attributed to injury to the aorta. An aortic
injury, when not lethal, often causes paraparesis or paraplegia due to
ischemia of the spinal cord. A fracture of the upper thoracic spine can
produce similar clinical and radiographic findings. The cases of three
patients who had those findings are presented; in all three, the
differential diagnosis between the vascular and skeletal injuries was
difficult. Fracture of the thoracic spine should be included in the
differential diagnosis whenever mediastinal widening is seen on
radiographs.