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A 73-year-old man with a previous history of hypertension and diabetes mellitus had undergone aortic-valve replacement for aortic stenosis and received a pacemaker for a junctional rhythm several years earlier. A routine follow-up chest x-ray film raised the possibility of an aortic-arch aneurysm. The pacemaker was functioning properly. What is the diagnosis?
Editor's note: We invite our readers to submit their answers at www.nejm.org/mystery. We will publish the diagnosis in the Correspondence section of the September 21, 2006, issue and e-mail it to everyone who submits an answer. All answers must be received by August 9, 2006.
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