A 40 year old man has fallen off a roof. He is shocked and has chest pain. There is a delay between the radial and femoral pulse. His CXR=widening of the mediastinum. What is the single most likely diagnosis?

The key is E. Traumatic rupture of the aorta. [A traumatic aortic disruption is caused by a rapid acceleration (or deceleration) causing a tear in the aorta. Normally this is immediately fatal, but those who survive may show a widened mediastinum on CXR. This can be confirmed with CT scan or angiography of the aorta and requires prompt surgical correction. Stable the haemodynamics and surgical correction. Note: pts with diaphragmatic rupture usually presents days after trauma with vague symptoms, history is vital].