title: An unusual finding in a 57-year-old woman with new onset hypertension and a diastolic murmur.
abstract: A 57-year-old woman presented to our clinic with breathlessness brought on while walking uphill. She had been recently diagnosed with systemic hypertension. There was no known family history of cardiac disease, or prior smoking habit. On examination, pulse was 73 bpm and blood pressure 155/73 mm Hg, which was asymmetrical in her arms. Auscultation revealed a readily audible early diastolic murmur in the aortic area and bilateral subclavian bruits. ECG showed sinus rhythm with no abnormality. Transthoracic echocardiography demonstrated mild-to-moderate aortic regurgitation, and normal left ventricular size and function. The ascending aorta was mildly dilated (41 mm), with para-aortic thickening noted. Owing to the abnormal appearance of the aortic wall, cardiac MRI, and subsequently18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) scan was performed (figure 1).
  
  
  
  Which complication of the underlying disease is evident in figure 1, panel C? Aortic aneurysmAortic dissectionAortic thrombusCoronary artery aneurysmCoronary sinus fistula.
authors.affiliation: Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Tarkin
authors.affiliation: Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK.
authors.forename: James H F
authors.identifier: 0000-0003-2243-3117
authors.initials: JH
authors.lastname: Rudd
authors.affiliation: Vasculitis and Lupus Service, Cambridge University Hospitals NHS Trust, Cambridge, UK.
authors.forename: David R
authors.initials: DR
authors.lastname: Jayne
authors.affiliation: Division of Cardiovascular Medicine, Cambridge University Hospitals and Papworth Hospital NHS Trust, Cambridge, UK.
authors.forename: Rosemary A
authors.initials: RA
authors.lastname: Rusk
authors.affiliation: Department of Radiology, Cambridge University Hospitals and Imperial College Healthcare NHS Trust, Cambridge, UK.
authors.forename: Deepa
authors.initials: D
authors.lastname: Gopalan
mesh_terms: D000072226:Computed Tomography Angiography; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D017023:Coronary Angiography / Q000379:methods; D004452:Echocardiography; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage; D006337:Heart Murmurs; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D013625:Takayasu Arteritis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18