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Contrast enhanced CT scan shows aneurysmal dilatation of the ascending aorta which contains an intimal flap. There are also evidence of previous sternotomy, aortic valve prosthesis, and right sided pleural effusion. Reflux of contrast agent into the coronary sinuses, pulmonary veins, and phrenic veins is evident. In addition, you can see the layering of the contrast material within the SVC where the formation of the blood-contrast level occurs under the influence of a large compressing aneurysm. Accumulations of the contrast material in the right chest wall veins and dependent dorsal veins of the back are also evident.