This week on #RadiologyRounds we have a patient with some key clues on the initial X-ray that help lead to the ultimate diagnosis.
![](https://www.pulmpeeps.com/wp-content/uploads/2022/05/1-1024x1024.jpeg)
![](https://www.pulmpeeps.com/wp-content/uploads/2022/05/2-1-1024x526.png)
While the patient has multiple findings on the X-ray, the mediastinal widening is the most concerning finding in the setting of acute chest pain, shortness of breath, and lightheadedness.
![](https://www.pulmpeeps.com/wp-content/uploads/2022/05/3-1024x1024.jpeg)
Mediastinal widening has a broad differential, which includes some can’t miss and life-threatening diagnoses
![](https://www.pulmpeeps.com/wp-content/uploads/2022/05/5-1024x1024.jpeg)
![](https://www.pulmpeeps.com/wp-content/uploads/2022/05/4-1-1024x479.png)
The key point is that aortic dissection, or ruptured thoracic aortic aneurysm, is high on the differential for this patient. Cross-sectional imaging is warranted and should be timed appropriately to evaluate the aorta. A triple rule-out CT would accomplish this as well. This patient had a CTA of the chest and was found to have a large type A aortic dissection with significant extension.
![](https://www.pulmpeeps.com/wp-content/uploads/2022/05/6-1024x1024.jpeg)