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.

Further reading https://emedicine.medscape.com/article/416776-overview#a2