Thoracic aortic aneurysm
The patient attend A and E with a fever. Chest x-ray performed as part of a 'septic screen'.
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Gross dilatated aneurysmal thoracic aorta, giving rise to a highly abnormal mediastinal outline.
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The majority of thoracic aortic aneurysms are atherosclerotic and thus typically elderly patients.
They are frequently asymptomatic and identified on chest imaging - radiograph or CT - performed for other purposes.