National Board of Chiropractic Examiners (NBCE) Practice Test

Widening of the upper mediastinum in a patient with Marfan syndrome is likely due to?

1. Aortic dissection

2. Pulmonary embolism

3. Pericardial effusion

4. Aortic aneurysm

The correct answer is: Aortic aneurysm

Widening of the upper mediastinum in a patient with Marfan syndrome is commonly associated with aortic aneurysms. Marfan syndrome is a genetic disorder that affects the connective tissue, leading to structural abnormalities, especially in the cardiovascular system. Patients with this condition often experience weakening of the aortic wall, which can result in an aortic aneurysm. As the aneurysm enlarges, it creates a bulge that can extend into the mediastinal area, giving the appearance of widening on imaging studies, such as a chest X-ray or CT scan. This widening can be a critical indicator of potentially serious complications, including the risk of aortic dissection and rupture, which are common in individuals with Marfan syndrome due to their predisposition for such vascular conditions. While aortic dissection could also lead to widening of the mediastinum, the primary association in the context of Marfan syndrome and the most direct reason for observed mediastinal widening is typically the presence of an aortic aneurysm. Therefore, selecting aortic aneurysm captures the specific structural vulnerability resulting from Marfan syndrome.