The frontal chest x-ray shows outward bulging of the left heart border, which is suggestive of left ventricular hypertrophy. The ascending aorta is dilated; the outer wall of the ascending aorta almost parallels the right heart border and this is due to post-stenotic dilatation. Overall, these findings are indicative of stenosis of the aortic valve.

The patient had further investigations and was diagnosed with a bicuspid aortic valve. A CTA of the aorta did not reveal aortic dissection.

Bicuspid aortic valve has an incidence of 0.5-2%. Patients with this condition can present to the emergency department with: 1. Thoracic aortic dissection; 2. Infective endocarditis; 3. Syncope.

Reference: Grainger and Allison’s Diagnostic Radiology, A Textbook of Medical Imaging.