To the Editor A recent Clinical Challenge reported the case of a 25-year-old female with incidental thoracic aortic aneurysm and bicuspid aortic valve (BAV).1 I am concerned that this article missed an important teaching point related to diagnostic workflow and did not identify the cause(s) of the thoracic aortic aneurysm and BAV, needed for diagnosis, treatment, and surveillance of this condition.2 In this young adult female, the family history of her father having an ascending aorta...