A 68-year-old man presents to the emergency department with sudden onset of severe chest pain radiating to his back. He describes it as tearing in quality. His blood pressure is 210/120 mmHg in the right arm and 160/90 mmHg in the left arm. What is the most likely diagnosis?

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Aortic dissection. The presentation of sudden tearing chest pain radiating to the back, along with significant blood pressure differences between arms (>20 mmHg), is highly suggestive of aortic dissection. This is a vascular emergency requiring prompt diagnosis and management.

A 68-year-old man presents to the emergency department with sudden onset of severe chest pain radiating to his back. He describes it as tearing in quality. His blood pressure is 210/120 mmHg in the right arm and 160/90 mmHg in the left arm. What is the most likely diagnosis?

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