48 year old man with sudden onset chest pain and hypotension

Chest

What are the findings? What conditions should you suspect given the history and this portable radiograph.?

Scroll down for additional images and description.

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Portable radiograph: Left pleural fluid collection and indistinct aortic border.

Axial non-contrast CT (left): Massive left pleural fluid collection with hyperdense component that corresponds in density to clotted blood.

Axial post contrast CT (right): Aortic intimal separation with small true lumen and large intramural (false) lumen.