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A 37-year-old man presented to the emergency department with chest pain of 2 days' duration. The pain was heavy in character, intermittent, and made worse by deep inspiration and lying flat. The man had no shortness of breath and had been actively working as a gardener until the onset of the pain. He was an active smoker, and his father had had a myocardial infarction at the age of 52 years. He did not have hypertension. Auscultation of the precordium was notable for an aortic regurgitant murmur. Electrocardiography showed left ventricular hypertrophy. Chest radiography revealed a widened mediastinum (Panel A). 3-D reconstruction computed tomographic angiography of the chest showed a 9.5-cm ascending aortic aneurysm (Panel B). The patient underwent an ascending aortic root replacement, during which the aneurysm was visible through the median sternotomy (Panel C), and a Dacron graft was successfully placed (Panel D). The patient had a full and uneventful recovery.
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