CASE PRESENTATION: A 60-year-old male with a medical history of hypertension and tobacco abuse presented to emergency department with a complaint of epigastric abdominal pain of 2 hours duration that radiated up to the left side of his chest. The patient had no history of pulmonary embolism or deep vein thrombosis. Initial electrocardiogram (EKG) revealed normal sinus rhythm with left ventricular hypertrophy. Troponin was negative. The patient decided to leave against medical advice however returned shortly after with cramping and severe right lower extremity pain. Physical exam was remarkable for non-palpable dorsalis pedis and posterior tibialis pulse with no Doppler signal. Computed Tomography (CT) dissection protocol revealed three small floating thrombi attached to lateral wall of the aorta within the aortic arch. CT angiogram of the right lower extremity revealed complete occlusion of the popliteal artery immediately proximal to the trifurcation at about the level of the knee. Limited hyper-coagulable work up was negative. The patient received catheter-directed thrombolytic therapy of his right popliteal artery and was started on systemic anticoagulation. In 6 months, on repeat CT dissection protocol, the aortic thrombi previously seen were no longer present.