Abstract
A 46-year–old man was admitted for severe back pain over the interscapular area radiating anteriorly along the ribs. Symptoms started intermittently 2 months previously, but became severe and persistent over the past 3 days. The patient was a former sailor and a heavy smoker, with no relevant personal or family history of cardiovascular disease. At physical examination, a pulsatile left paravertebral mass could be seen and palpated close to the spine (online-only Data Supplement Movie I). A high-pitched descrescendo diastolic murmur could be heard along the left sternal border. He was normotensive and tachycardic, with no signs of pulmonary or systemic congestion. The ECG showed sinus tachycardia (115 beats per minute) and complete right bundle-branch block with secondary ST-T …
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