Chest and cardiac imaging: calcium sign of aortic dissection: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Chest and cardiac imaging: calcium sign of aortic dissection

Sample item

A hypertensive man with tearing chest pain has a widened mediastinum on chest film. Which radiographic finding supports aortic dissection in particular?

ABilateral apical pleural thickeningBIntimal calcification displaced inward from the outer aortic wallCCalcification confined to the aortic knuckle with normal wall thicknessDA double-density right heart border

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Intimal calcification displaced inward from the outer aortic wall

In dissection, blood in the false lumen separates the calcified intima from the outer wall, so the calcium appears displaced inward, called the calcium sign. Widened mediastinum, a left apical cap and pleural effusion may accompany it. CT angiography then confirms the diagnosis.

Option by option

A. Bilateral apical pleural thickening
Apical thickening is a chronic pleural change.
B. Intimal calcification displaced inward from the outer aortic wall (correct)
Correct. Inward displacement of intimal calcium suggests dissection.
C. Calcification confined to the aortic knuckle with normal wall thickness
Calcification at the knuckle is common with atherosclerosis and is not specific.
D. A double-density right heart border
A double right heart border indicates left atrial enlargement.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is B, Intimal calcification displaced inward from the outer aortic wall. In dissection, blood in the false lumen separates the calcified intima from the outer wall, so the calcium appears displaced inward, called the calcium sign.

Why is "Bilateral apical pleural thickening" not the answer?

Apical thickening is a chronic pleural change.

Why is "Calcification confined to the aortic knuckle with normal wall thickne…" not the answer?

Calcification at the knuckle is common with atherosclerosis and is not specific.

Why is "A double-density right heart border" not the answer?

A double right heart border indicates left atrial enlargement.

What concept does this question test?

It tests Chest and cardiac imaging: calcium sign of aortic dissection in Radiology. Widened mediastinum, a left apical cap and pleural effusion may accompany it. CT angiography then confirms the diagnosis.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Chest and cardiac imaging: calcium sign of aortic dissection?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.