A 70 –Year- Old Man with Shortness of Breath – What Lies Beneath?

We describe a 70-year-old man who presented to our emergency department with worsening shortness of breath. His chest roentgenogram showed pulmonary congestion and his condition improved with heart failure treatment yet a repeat chest roentgenogram revealed an abnormality which had remained unnoticed in his first chest x-ray due to the underlying congestion in lung fields. Descending aorta was dilated and very prominent. Further work-up showed a type B dissection which seemed to be chronic. Considering the chronicity of the condition, the fact that it was actually asymptomatic and the patient’s fragile condition we decided not to proceed with surgery.