A) At the time of acute chest pain and dyspnoea, the chest radiograph showed a marked increase of the enlargement of the right pulmonary trunk (arrow).

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a) At the time of acute chest pain and dyspnoea, the chest radiograph showed a marked increase of the enlargement of the right pulmonary trunk (arrow). b and c) Computed tomodensitometry scans of the chest demonstrating extensive dissection of the right pul... a) At the time of acute chest pain and dyspnoea, the chest radiograph showed a marked increase of the enlargement of the right pulmonary trunk (arrow). b and c) Computed tomodensitometry scans of the chest demonstrating extensive dissection of the right pulmonary artery starting from the intermediate branch and progressing to subsegmentary branches of right middle and lower lobe artery. The arrows indicate the intimal flap. #: the false lumen within the pulmonary arterial tree. d) There was no evidence of pericardial effusion on the computed tomodensitometry scan. The arrow indicates the enlarged right ventricle. B. Degano et al. Eur Respir Rev 2009;18:181-185 ©2009 by European Respiratory Society