Imaging Case of the Week 180 Answer

The frontal chest x-ray shows a widened mediastinum with a prominent aortic arch. The trachea is displaced towards the right. The chest x-ray features are concerning for a dissecting aortic aneurysm.

mediastinal widening

This patient went on to have a CTA chest which showed a Stanford type-B aortic dissection.

axial CT aortic dissection

coronal CT aortic dissection

sagittal CT aortic dissection

Stanford A – affects the ascending aorta. Surgically managed.

Stanford B – affects aorta distal to the origin of the left subclavian artery. Mostly medically managed.