A 54-year-old man is brought to the emergency room from his doctor's office.

Chart

A 54-year-old man is brought to the emergency room from his doctor's office. Chief complaint is sudden onset of severe chest discomfort. Discomfort had a tearing nature.

Decreased red blood cell count. EKG is normal. Chest x-ray shows evidence of an aneurysm of the ascending aorta. Transesophageal echo shows separation of the layers of the ascending aorta.