An aortic dissection (AD) occurs when the inner layer of the aorta tears. ADs have a predilection toward men and those aged 60 to 70 [1]. Type A aortic dissections are more dangerous due to the tear situated in the ascending aorta whereas Type B is more rare with the tear limited to the descending aorta. Symptoms of aortic dissections such as chest pain are similar to other cardiovascular conditions, making aortic dissection detection tricky [1,2]. We report a 74 year old female with constant chest pain radiating from the right breast to the right upper quadrant after eating Chinese food for dinner. The pain was accompanied with non-radiating back pain and nausea. Physical examination was significant for a tender mass palpated in the right upper and lower quadrants. Right upper quadrant ultrasound showed choledocholithiasis with common bile duct dilation at 1.1cm, unchanged from 1 year prior, and sludge in the gallbladder but no cholecystitis. Her vitals were stable with mild hypertension (149/67 mmHg). Endoscopic ultrasound examination showed a gallbladder filled with stones and sludge as well as a thickened wall consistent with possible cholecystitis. Mild intrahepatic biliary dilation was present. The celiac axis, superior mesenteric vessels, splenic vessels and portal vein were normal. Type B Dissection of the thoracic aorta and aortic arch was identified in the endoscopic ultrasound. Traditionally, CTs with contrast dye, echocardiograms and MRIs are commonly used to diagnose AD [1]. Meanwhile, endoscopic ultrasound (EUS) provides clear images to facilitate the diagnosis of gastrointestinal conditions. Our case highlights that EUS can also be used to examine cardiovascular disorders. EUS offers complete visualization of the aortic valve, the mitral valve, ascending and descending aorta, pericardium, left atrial appendage, and interatrial septum [3]. The proximity of the aorta to the esophagus allows for a very detailed view of the aorta [2,3]. It is essential that every complete endoscopic ultrasound exam include an evaluation of the thoracic organs in order to capture critical incidental findings that would be otherwise missed.2139_A Figure 1. Type B aortic dissection as seen on endoscopic ultrasound.2139_B Figure 2. Type B aortic dissection as seen on endoscopic ultrasound.