Imaging Case of the Week 468 Answer

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