Presentation
Chest pain for investigation.
Patient Data
Lungs and pleural spaces are clear. Cardiac silhouette is not enlarged. Prominent aortic arch and descending thoracic aortic silhouette is enlarged.
Aortic dissection arising distal to the left subclavian artery extending to the abdominal aorta (and out of the field of view). Large false lumen is poorly opacified, with a smaller well opacified true lumen. No extension into the aortic arch branches. Celiac, superior mesenteric and left renal artery arise from the true lumen. Right renal artery is not well opacified. Partially thrombosed splenic artery aneurysm.
Case Discussion
Assessing the aortic silhouette is important when reviewing chest x-rays. An enlarged silhouette is helpful as a clue to the cause of chest pain, although a normal aortic silhouette is not helpful as a normal caliber aorta can (uncommonly) still have a dissection.
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