Aortic valve stenosis

Case contributed by Frank Gaillard
Diagnosis certain


Limited exercise tolerance with mild shortness of breath on exertion.

Patient Data

Age: 40 years
Gender: Male

Chest x-ray


Chest x-ray shows prominent of the right mediastinal border occupied by the ascending aorta. The descending aorta is unfolded but of normal caliber. Heart size is normal. No lung or pleural abnormality. 

CT chest


CTA of the thorax confirms enlargement of the ascending aorta with a normal caliber descending aorta. Non-contrast CT image depicts aortic valve calcification. 

Annotated images

Annotated image

The ascending aorta (yellow dotted line) leading into the arch is dilated, whereas the distal arch and descending aorta (red dotted line) are normal in size. The left heart border (blue dotted line) can be traced upwards along the mediastinum to blend with the aortic arch, explaining why the medial (left) border of the ascending aorta is not visible on x-rays. 

Calcified aortic valve (green arrows) noted on CT. 

Case Discussion

The growth in the use of cardiac echocardiography has diminished the need for a detailed understanding of changes in the cardiac silhouette due to cardiac disease. However, it is still essential that as a radiologist one is able to alert physicians to the presence of asymptomatic disease. In this case, identifying aortic stenosis before severe symptoms develop may prevent irreversible cardiac changes. 

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