The chest x-ray (AP x-ray done in resus area) shows a widened mediastinum with prominent aortic knuckle. The appearance in the context of concerning chest pain should raise suspicion for an aortic dissection. The patient went onto have a CT aortogram which confirmed a Stanford A aortic dissection.
CT images from the same patient –
The patient underwent emergency surgery and survived.
Chest x-ray features are nonspecific in a patient with aortic dissection. Following abnormalities could be present.
- Mediastinal widening.
- Double aortic knob sign.
- Enlarged aorta with poorly defined aortic contour.
- Inward displacement of the aortic wall calcification by more than 10mm (calcium sign).
- Cardiac enlargement (pericardial effusion).
- Left sided pleural effusion.
- Left apical opacity (apical cap).
- Tracheal displacement to the right.
Further reading https://emedicine.medscape.com/article/416776-overview#a2