José Vilar and Friends Case 11 (Update: Solution!)

Dear Friends,

This time I have the privilege to count with the help of Dr. Lucía Flors, and Dr. Jeff Kuni from the Department of Radiology, University of Missouri, Columbia.

Dr. Flors was a brilliant radiology resident not long ago at Hospital Universitario Dr. Peset.

Lucía and Jeff have lots of interesting cases and, to prove it, here is one of them.


These radiographs belong to a 65-year-old female with chest pain.

Actual radiographs.

Previous examination one year before.

Let us hear your thoughts and remember that the main objective of this blog is not to get the exact diagnosis (which is not bad of course) but to find the correct approach to the images and the clinical scenario.

Click here for the answer

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    May 2019
    DISCUSSION 9 Comments

    9 Responses to : José Vilar and Friends Case 11 (Update: Solution!)

    1. Fingers crossed says:

      Widened mediastinum with loss of retrosternal space on lateral view, also we can see dilatation of thoracic aorta.
      Ddx anterior mediastinal mass, aortal aneurysm.

    2. José Vilar says:

      Fingers closed you are reading well the images, any possible diagnosis?

    3. nat bi says:

      also, irregular aortic contour-double aortic contour on both views and deviation of svc- aortic dissection? type A Stanford classification. on previous films there was aneurismal dilatation- aneurysm of ascending aorta and aortic arch.
      i think there was irregular contouring in the previous films (latteral projection or figure of 3 sign?)

    4. nat bi says:

      and i cant see any evidence of atherosclerotic disease on main vessels or the heart vessels.. so it could be aortic dissection due to coarctation of aorta in the pressence of high blood pressure.

    5. Ilaria says:

      Good morning!
      Widened mediastinum with ascending aorta dilatation
      Double contour of ascending aorta.
      Loss of retrosternal space in LL view. Cardiac enlargement more evident than in previous films
      Imaging findings together with clinical scenario, are suspect for aortic aneurysm with probable rupture
      and haemomediastinum.

    6. nat bi says:

      i think the aortic contour is fairly clear on both views in the more recent radiographs, and i think there is no real widening of the heart shadow, wich can be better comparable on the lateral views, i think its just displacement of the heart due to the aneurysm, so there is no evidence of aortic rupture. but i could be really wrong

    7. Fingers crossed says:


    8. dr sami says:

      widening of medistenum and retro sternal space

    9. Tonanto says:

      someone can please tell what kind of disease is that?