The frontal chest x-ray shows an aneurysmal descending thoracic aorta. In the context of sudden chest and epigastric pain, this patient likely has a thoracic aortic dissection. CT scan of the chest confirmed the presence of a thoracic aortic dissection in the descending thoracic aorta (Stanford Type B).

Chest x-ray is not a sensitive test to diagnose thoracic aortic dissection but it may reveal indirect signs of dissection – aneurysmal dilatation of aorta, widened mediastinum, abnormal aortic contour etc.