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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 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 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.