We thank McKenzie1 for his interest in our work. Indeed, acute aortic dissection should be considered in all individuals presenting with chest pain. A summary of Canadian Medical Protective Association data from 1991–2005 of patients with proven aortic dissection where medicolegal difficulties arose found that 44% of patients had pleuritic or positional chest pain, and a presumptive diagnosis of pericarditis was made in 12% of these patients.2 As the diagnosis of aortic dissection may elude even the most experienced clinician, it is important to maintain this on one’s differential diagnosis and ensure that appropriate investigations and a treatment plan are instituted to address this diagnostic possibility. This is especially important because aortic dissection may masquerade as other common clinical conditions.