Famous Patients, Famous Operations, 2003 - Part 3: The Case of the Climber With Chest Pain

Albert B. Lowenfels, MD

Disclosures

May 20, 2003

Introduction

Chief Complaint: A middle-aged man experienced a sudden, sharp pain in his left chest while climbing alone in the mountains in the spring. The pain was associated with weakness and numbness in his left arm and hand. There were no previous known similar episodes. The pain was severe and persisted until he died, several hours after the onset.

Past History: He had been in generally good health prior to the present illness, but sometimes complained of pain in several of his larger joints. He had occasional, mild bouts of diarrhea. He was a non-smoker; his alcohol consumption was unknown.

Disease Course: His pain was steady over the next few hours. He became very weak and was unable to walk; he sought relief by resting on a snow-covered rock ledge, where he remained until his death. Many years later, when his frozen intact body was discovered, partially buried by snow and ice, an autopsy was performed by forensic pathologists. The postmortem examination, which included conventional plain radiographs and computerized tomography (CT) scans of the chest, as well as DNA testing, revealed the cause of death.

Who was our mystery patient?

  1. Alexander the Great

  2. Sir Edmund Hillary

  3. Hannibal

  4. Otzi (AKA the "Iceman")

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What was the probable cause of the sudden onset of chest pain?

  1. Spontaneous pneumothorax

  2. Ruptured aneurysm of the thoracic aorta

  3. Penetrating chest wound

  4. Myocardial infarction

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What vital structures were likely to have been affected?

  1. Left lung

  2. Brachial plexus

  3. Subclavian artery

  4. Any of the above

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