A 49-year-old man with a history of hypertension presented to the emergency department because of chest pain and syncope. Acute coronary syndrome was suspected; both ECG and laboratory test were negative. Echocardiography demonstrated a dilated ascending aorta (56 mm), and a mildly regurgitant bicuspidal aortic valve; neither left ventricular wall motion abnormalities nor pericardial effusion were detected. Aortic dissection was suspected and the patient underwent transoesophageal echocardiography. The …