In a patient with tearing chest and back pain and a diastolic murmur, what is the expected finding on chest radiograph?

• A. Normal
• B. Pleural effusion
• C. Decreased lung volume
• D. Widened mediastinum

Answer: (D)

The tearing chest and back pain with a diastolic murmur points to an acute aortic dissection causing aortic regurgitation. On chest radiography, the expected finding is widening of the mediastinal silhouette. This widening reflects dilation of the aorta and the presence of a dissection flap, which expands the mediastinum. While radiographs can sometimes be normal early on or show other findings like pleural effusion if rupture occurs, mediastinal widening remains the most characteristic and commonly expected clue in this scenario. If suspicion remains high, use CT angiography or transesophageal echocardiography for definitive assessment.