CASE PRESENTATION: A 75-year-old male with a history of type 2 diabetes and hypertension presented from his primary care physician’s office after complaints of fatigue, vague non-radiating, intermittent chest pain and poor appetite. Examination on admission revealed an afebrile man without tachypnea or tachycardia and an otherwise normal cardiac examination with symmetric distal pulses. A chest radiograph demonstrated a widened mediastinum followed by a CT angiogram which showed significant aortic wall inflammation from the left subclavian artery and extending down the descending aorta with associated emphysematous aortitis (Figure 1). Blood cultures were positive for Clostridium septicum for which he was started on piperacillin/tazobactam and beta-blockade for blood pressure control. Further imaging showed diverticulosis and diffuse colitis. He was treated conservatively with IV antibiotics and his bacteremia resolved with dramatic improvement in the emphysematous aortitis (Figure 2) He was discharged on antibiotics with plans for open surgical repair when antibiotic therapy was completed.