A 34 year old woman who is 3 days post-partum has presented with a sudden onset of central chest pain at 3 am. She has no previous medical illness. As part of investigations, a chest x-ray has been done and is as follows. What is seen on the x-ray? (It is very subtle)
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At first glance, the chest x-ray appears normal. The lung fields are clear; there is no pneumothorax to account for the sudden onset of pain. However, there is a subtle finding on the cardiac outline which raises the possibility of proximal aortic dissection.
There is a diffuse bulge along the superior aspect of the right heart border, causing focal widening of the mediastinum. This finding is due to aortic root dilatation associated with dissection (Stanford A).
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This patient had a confirmed proximal aortic dissection on CTA. A slice of axial post contrast CT chest is as follows and shows intimal flap in the mildly dilated ascending aorta (diameter is 4.5 cm).
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