Man Coughing up Blood, Has Back Pain – Let’s Diagnose

A 58-year-old man with history of atherosclerosis went to the ED when he started coughing up blood. He appeared quite ill as he reported chest pain and shortness of breath. He said he had also had some abdominal and low back pain for several days. During the exam, the doctor heard wheezing and noted elevated blood pressure. The patient’s wife also pointed out that he didn’t normally have such a hoarse voice.

Is it aortic dissection, pulmonary embolism, bronchitis, or thoracic aortic aneurysm?

The correct answer is…

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