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An 82-year-old man with hypertension, hypercholesterolemia, and chronic obstructive pulmonary disease presents to the emergency department with severe back pain. He also feels diaphoretic and nauseous. The patient states he is usually compliant with his medications but sometimes forgets to take them. He denies any alcohol use or illicit drug use. His temperature is 37.1°C (98.7°F), blood pressure is 165/104 mm Hg, pulse is 112/min, respiratory rate is 18/min, and oxygen saturation is 94%. On physical examination there is no jugular venous distension, and there are diminished but equal pulses bilaterally in the lower extremities. Cardiovascular examination reveals regular rate and rhythm without murmurs, rubs, or gallops. Because the patient has an allergy to CT contrast dye, an MRI of the chest is performed and is shown in the image below.
Which of the following is the most likely diagnosis?
A. Aortic dissection
B. Lumbar disc herniation
C. Pancreatic cancer
D. Perforated peptic ulcer
E. Ruptured aortic aneurysm
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