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A Penetrating Issue

Published:September 10, 2022DOI:https://doi.org/10.1016/j.jemermed.2022.09.013
      An 83-year-old man with a history of hypertension presented to the Emergency Department (ED) with acute onset of nonexertional chest pain for one day. He denied associated complaints. Vital signs were blood pressure 103/70 mm Hg, pulse 136 beats/min, and temperature 36.9°C. Physical examination was unremarkable. A computed tomography angiography of the thoracic aorta was obtained to exclude aortic dissection (Figures 1 and 2).
      Figure 1
      Figure 1Axial computed tomography aortogram image demonstrates a focal, contrast-filled aorta (asterisk) with outpouching of the descending thoracic aortic wall (arrows) in the absence of a dissection flap or separate lumen consistent with a penetrating atherosclerotic ulcer.
      Figure 2
      Figure 2Sagittal computed tomography aortogram image demonstrates a focal, contrast-filled aorta (asterisk) with outpouching of the descending thoracic aortic wall (arrows) in the absence of a dissection flap or separate lumen consistent with a penetrating atherosclerotic ulcer.

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