Images in a 62-year-old man who presented to the emergency department with acute chest pain.(A) Short-axis view of the aortic root,(B) threechamber view,(C–E) three-dimensional volume-rendered images, and (F) intraoperative view after median sternotomy with extracorporeal circulation show an eccentric bulge of the right aortic sinus (R) with the presence of a focal limited tear (arrowhead). This is represented by focal linear “flaps” with undermined edges, as a bandlike outpouching where the right coronary artery (RCA) took off. The patient underwent graft replacement of the ascending aorta and aortic valve replacement. AA= ascending aorta, LA= left atrium, LV= left ventricle, LM= left main artery, R/L/NC= right/left/noncoronary aortic sinus.