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.