A 50 year old lady presents to emergency department with sudden severe chest pain radiating to both shoulder and accompanying SOB (shortness of breath). Examination: cold peripheries and paraparesis. What is the single most appropriate diagnosis?

The key is B. Aortic dissection. [Cold peripheries due to reduced blood flow to distal parts of

dissection. Paraperesis or paraplegia due to spinal cord ischemia and infarction as a presenting

manifestation of aortic dissection has been found in 2 to 5 % of patients. Usual management for type A

dissection is surgery and for type B is conservative].