A 21-Year-Old With Sudden, Severe Chest Pain: Osmosis USMLE Study Question

January 08, 2021

The vignette describes a traumatic aortic dissection, a rare but life-threatening condition that is considered a medical emergency. A tear occurs in the aortic intima (shown at point 3 in the image), allowing high-pressure blood into the media, which separates from the intima. This creates a false lumen, shown in dark red, which is distinct from the true lumen (shown at point 4 in the image), which fills with blood and separates the intima and media even further away from the initial intimal tear. The propagation of the dissection causes many of the clinical manifestations of aortic dissection, including ischemia, aortic regurgitation, and cardiac tamponade.

If the dissection leads to impaired blood flow to peripheral vasculature, a unilateral or bilateral pulse deficit may occur. Aortic dissection is usually definitively diagnosed by CT, MRI, or transesophageal echo. It is a surgical emergency. Surgery aims to resect the most damaged portions of the vessel and obliterate the false lumen.

Major Takeaway: Aortic dissections with vascular compromise require emergent surgery.

Read more about aortic dissection.

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