In the described trauma scenario, the nasogastric tube deviation to the right in the upper mediastinum most strongly suggests injury to which structure?

• A. Esophagus
• B. Lungs
• C. Aorta
• D. Trachea

Answer: (C)

In the upper mediastinum, the esophagus runs behind the trachea and tends to sit toward the left of the midline. A traumatic injury to the aorta can cause a mediastinal hematoma that expands and pushes the left-sided mediastinal structures, including the esophagus, toward the right. Because the nasogastric tube travels down the esophagus, displacement of the esophagus to the right causes the tube to deviate to the right. This makes aortic injury the most likely explanation for that finding.

Injury to the esophagus would cause signs of perforation rather than a systematic rightward shift of the tube. Tracheal injury would primarily affect the airway and could misplace the tube into the trachea rather than producing a rightward deflection of the tube in the mediastinum. Lung injury wouldn’t specifically account for the observed shift of the esophageal course.