Chest radiograph belongs to a 24-year-old man with occasional episodes of fainting, currently asymptomatic.
What do you see?
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Findings: PA chest radiograph shows convexity of the right outline of the middle mediastinum (A, arrow), suggesting dilatation of the ascending aorta. Some of you have mentioned aortic coarctation, which is not a good option because rib notching is not visible, and the aortic knob is unremarkable.
Given the patient´s age, a good possibility is congenital aortic stenosis.
Enhanced sagittal CT reconstruction shows dilatation of the ascending aorta (B, asterisk) and heavy calcification of the aortic valve (B, arrow). Axial CT demonstrated a malformed and calcified aortic valve (C, circle).
Final diagnosis: congenital aortic valve stenosis with post-stenotic dilatation
Congratulations to Renga, who was the first to mention the ascending aorta dilatation.
Teaching point: the middle third of the mediastinum is occupied by the aorta and pulmonary artery. Any mediastinal abnormality in this area should be suspected to have a vascular origin.
You can see on our youtube channel the webinar Prof. Cáceres has prepared discussing this case and others.