Thoracic aortic aneurysm

Case contributed by Ian Bickle

Presentation

Chest pain and shortness of breath.

Patient Data

Age: 80 years
Gender: Female
x_ray

Even allowing for projection the mediastinum is widened.

The aortic arch and descending thoracic aorta are enlarged with mass effect on the trachea which is displaced to the right.

Lungs clear.

Radiograph from 2 years prior

x_ray

The aortic arch and descending thoracic aorta are dilated with mass effect on the trachea which is displaced to the right.

Heart size normal. Lungs clear.

Case Discussion

In the majority of cases a dilated thoracic aorta on a chest radiograph in an elderly patient it is due to ectasia (sometimes referred to as unfolding of the aorta).

In this case, it is true aneurysmal dilatation which was confirmed on a CT (not available).

These radiographs also illustrate the magnification differences of a PA and AP projection on the mediastinal structures.

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