Imaging Case of the Week 526 Answer

The chest x-ray view shows a widened mediastinum.

The above chest x-ray, in the clinical context is concerning for a possible aortic dissection. The x-ray shows widened mediastinum, double aortic contour & an outward bulge in the area of ascending aorta.

The patient had Stanford A aortic dissection on CT aortogram and underwent immediate surgery.

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.
  • Depression of the left main bronchus.

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