Complex thoracoabdominal aortic aneurysm repairs are preferably done by a staged approach, using the elephant trunk procedure. Postoperatively, such patients can present as a diagnostic dilemma if subjected to radiologic diagnostic studies such as computerized tomographic (CT) scanning or magnetic resonance imaging (MRI) of the thoracic cavity. The authors report a patient who presented with symptoms of chest pain and underwent CT scanning and subsequently MRI of the chest. Both scans were interpreted to be consistent with aortic dissection; however, the elephant trunk prosthesis was responsible for simulating a dissection.