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Question: A 66-year-old male with a history of hypertension presents to the emergency department with dyspnea and sharp abdominal pain radiating to his back. On examination, his blood pressure is 180120 mm Hg. A CT scan demonstrates the findings seen here and laboratory testing indicates that his renal function is preserved.

Which of the following is the most appropriate next step given this patient’s likely diagnosis?

A. Embolization

B. Antihypertensive therapy

C. Surgical repair

D. Thrombolytic therapy

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Details: This patient’s presentation and imaging findings are suggestive of aortic dissection, a tear in the intimal layer of the aorta resulting in a true and false lumen. This dissection is classified as a type B according to the widely used Stanford system, as it is confined to the descending aorta. Patients with a type B dissection who are hemodynamically stable may be managed medically with antihypertensive therapy and serial imaging. Indications for surgery include persistent hypertension or pain, or occlusion of a major aortic branch leading to end-organ ischemia. Acute type A dissections, which involve the ascending aorta, are considered surgical emergencies.

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