A 59-year-old male was admitted through the emergency room after falling from a ladder at a height of 12 feet. He sustained multiple fractures including a complicated proximal humeral and radial fracture. His cardiovascular physical examination was significant for a 2/4 diastolic murmur. His admission ECG (Figure 1) showed sinus rhythm with a heart rate of 59 bpm, first degree atrioventricular block and premature atrial contractions. His portable chest x-ray ( Figure 2) was significant for cardiomegaly, multiple rib fractures, and multiple calcifications projecting over the cardiac silhouette. Because of these abnormal findings and in preparation for his orthopedic surgery, the patient underwent a transthoracic echocardiogram, which revealed a massively enlarged aortic root with large sinuses of Valsalva aneurysms measuring Ϸ10 cm in diameter (Figure 3). Moderate to severe aortic regurgitation was present, and left ventricular function was normal. The patient was further evaluated by computerized tomography of the ascending aorta ( Figure 4A and 4B). This imaging modality further confirmed the findings in the echocardiogram. The presence of a layered thrombus was also noted within the dilated sinuses. Because of these features, the coronary arterial anatomy was not reliably imaged.Further investigation revealed a previous aortogram done 3 years previously at a different institution where the patient presented with complaints of mild nonexertional chest discomfort that later subsided. This previous study revealed similar findings of a dilated aortic root that already existed at

Paget disease of the cervical spine is a common disease in an uncommon location. The authors present an unusual case of a 58-year-old woman with a pathological fracture through the base of the odontoid vertebra secondary to Paget disease. The purpose of this case report is to describe the radiological features of Paget disease and their important application to treatment management.