Presentation
Sudden onset epigastric pain, radiating to the back
Patient Data
There is displacement of aortic arch calcification away from the aortic silhouette. This indicates lifting of the intimal calcification.
The heart contour is enlarged, with splaying of the carina to indicate left atrial enlargement. Lung detail has been obscured by the heavy windowing, and while there was no air space opacity a small left pleural effusion is present.
The comparison x-ray from 2 years earlier shows that the displaced calcification is a new finding.
Contrast is seen filling both the true and false lumens of a type A thoracic aorta dissection. The dissection flap commencing at the aortic root and extending distally. The ascending aorta is also dilated. The displaced calcium seen on x-ray is clearly visible on CT.
Case Discussion
This case highlights the utility of chest x-ray as a 'quick investigation' which can alter the management of a patient radically. In this case the chest x-ray was requested along with an abdominal x-ray, looking for a cause for the patient's epigastric pain. The displaced calcium allowed the possibility of aortic dissection to be raised, which was confirmed on subsequent CT angiogram.
The patient was deemed unsuitable for open repair, and conservative management was adopted. The patient is still alive 3 years later.
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