<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A previously healthy 32-year-old man comes to the physician because of a 1-week history of upper back pain, dyspnea, and a sensation of pressure in his chest. He has had no shortness of breath, palpitations, fevers, or chills. He emigrated from Ecuador when he was 5 years old. He does not smoke or drink alcohol. He takes no medications. He is 194 cm 6 ft 4 in tall and weighs 70.3 kg 155 lb; BMI is 19 kgm2. His temperature is 37.2C 99.0F, pulse is 73min, respirations are 15min, and blood pressure is 15286 mm Hg in the right arm and 13072 mg Hg in the left arm. Pulmonary examination shows faint inspiratory wheezing bilaterally. A CT scan of the chest with contrast is shown. Which of the following is the most likely underlying cause of this patients condition?? A: Infection with Trypanosoma cruzi, B: Cystic medial necrosis, C: Large-vessel vasculitis, D: Atherosclerotic plaque formation, E: Congenital narrowing of the aortic arch,  <response>: Based on the patients symptoms of upper back pain, dyspnea, and chest pressure along with the CT scan findings, this appears to be a case of aortic dissection likely due to cystic medial necrosis. The patient is relatively young for atherosclerotic disease and has no risk factors. There is no evidence to support infection, vasculitis, or congenital narrowing. The CT scan shows a dissection flap in the ascending aorta, which is classic for aortic dissection. Cystic medial necrosis is a degenerative process of the aortic media that can lead to aortic dissection in younger patients.B: Cystic medial necrosis 