Shifting calcium plaque in progressive aortic dissection.

An 80-year-old man with a 1-day history of chest pain was referred to our cardiology clinic. The patient’s right arm blood pressure, pulse, and temperature were found to be 81/53 mm Hg, 71 beats/min, and 37.4°C, respectively. Electrocardiography was unremarkable. Chest radiography revealed a widened mediastinum and a small amount of pleural effusion at the left costophrenic angle (Figure A and B). A linear calcium plaque was noted at the aortic knob, located 5 mm from the outer wall (Figure C, arrows). Results of blood examination indicated a d-dimer level of 5.6 μg/mL. The patient was diagnosed with aortic dissection; however, he refused hospitalization despite being provided with the knowledge of the lifethreatening nature of his condition. He presented again at our clinic 5 days later with hoarseness. Chest radiography revealed further widening between the calcium plaque and the outer wall of the aorta (Figure D, arrows). Despite intensive persuasion, he refused emergency surgery and died 2 days later.