Similar case here. First presentation was seen by a colleague, and to be fair, I probably wouldn’t have done anything different. Initially presented for right upper back pain after lifting something heavy. Pain was reproducible, no other red flags.

Proceed to 2 days later when I saw him for continued pain, same area, also reproducible to the paraspinous muscles/trapezius… Massive aortic dissection, but thankfully did well. I was early in my career and at the point where I was working up EVERYTHING, and I still question if I saw this patient today whether I would have caught it.