A 60-year-old male, chron...

A 60-year-old male, chronic smoker, presented with low-grade fever, cough, and wheezing for the past month. Chest X-ray PA revealed unfolding of the aorta with mediastinal widening. CECT chest indicated fusiform dilatation of the aortic arch (diameter 6 cm) with a mural thrombus measuring 28 mm x 70 mm. An abdominal aortic aneurysm with a diameter of 7.5 cm was also noted. The patient was initiated on Beta blockers and anticoagulants and advised to seek a cardiothoracic vascular surgery (CTVS) opinion. The lesson to be learned is to thoroughly investigate the causes of mediastinal widening, as diagnoses such as root and arch aneurysms are life-threatening. Timely diagnosis and intervention are essential.