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©2013 UpToDate ® Print Email Aortic dissection PA chest film in a patient with the sudden onset of excruciating interscapular pain and hypotension. The ascending aortic arch is dilated, displacing the trachea to the right (black arrow). A left lower lobe density is suggestive of a pleural effusion. Surgery revealed a dilated ascending aorta with a dissection approximately 3 cm distal to the aortic valve. Courtesy of Robert A Novelline, MD.