Snapshot A 40-year-old woman presents to her primary care physician for a wellness exam. She currently does not have any acute concerns and reports to feeling well. She has not seen a physician in 20 years but presents today to be tested for sexually transmitted infections at the request of her new partner. She says she may have had a vaginal sore about 17 years ago. She had many sexual partners and infrequently uses condoms. On physical exam, cardiac auscultation is significant for a tambour-like quality S2 heart sound along with a diastolic decrescendo murmur in the left sternal border. A chest radiograph demonstrates calcifications of the ascending aortic arch. Introduction Clinical definition login to view 2 more bullets Pathogenesis login to view 3 more bullets Imaging Radiography of the chest login to view 3 more bullets