I was under the impression that this was an aortic dissection, due to "severe chest pain" as well as the false lumen in the aorta. And HTN is the #1 risk factor for aortic dissection. Someone correct me if i'm wrong, but I think this is aortic dissection rather than aortic aneurysm.

Robbin's: The two most important causes of aortic aneurysms are atherosclerosis and hypertension. Atherosclerosis is the more dominant factor in abdominal aortic aneurysms, while hypertension is associated with ascending aortic aneurysms.

Hypertension can lead to aneurysms like in this patient. Not syphilis because not thoracic aorta.

This is not an aneurysm, which is what makes this question so weird: "x-rays of the chest do not show widening." My understanding was that dissections usually occur in the picture of aneurysm, especially due to hypertension. However, perhaps that's not the case, particularly in these Stanford Type A dissections? The picture in FA sure makes it look like a widened aorta (aneurysm) with a dissection...

This is an AORTIC DISSECTION: No. 1 RF is HTA, intimal tear forming a false lumen and the pain sudden onset radiates to the back.

FA 2017: 3° syphilis disrupts the vasa vasorum of the aorta with consequent atrophy of vessel wall and dilatation of aorta and valve ring. May see calcification of aortic root, ascending aortic arch, and thoracic aorta. Leads to “tree bark” appearance of aorta. Can result in aneurysm of ascending aorta or aortic arch, aortic insufficiency.