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A 46 year old man presented to his general practitioner with coryzal symptoms. His practitioner incidentally auscultated a precordial murmur and thus referred the patient for transthoracic echocardiography, which showed left ventricular dilatation (7.4 cm, thin arrow) in association with severe aortic regurgitation and a dilated aortic root (10 cm). The patient was asymptomatic but recalled that 10 years earlier, a 130 kg man fell onto his chest while playing cricket and fractured his sternum. He was not marfanoid in appearance. Cardiac magnetic resonance imaging (MRI) showed a 10.4 cm (anteroposterior and coronal diameter) thoracic aortic aneurysm (thick arrow) involving the aortic annulus (4.2 cm) and ascending aorta, extending up to the origin of the right subclavian artery but not the carotids. The patient underwent aortic valve replacement and aortic root and ascending aorta replacement and currently remains well. Whether the history of major chest trauma is relevant and contributory to his pathology is impossible to say.
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