A 55-Year-Old Man With Severe Chest Pain: Osmosis USMLE Study Question of the Week

March 20, 2020

The CT shows a massively enlarged aortic arch, and the given history of tearing chest pain that radiates to the back is classic for a dissecting aortic aneurysm. An aortic dissection is caused by a tear in the aortic intima that then fills with blood to create a false lumen.

In this image, the aorta has ruptured, and the black arrow represents the thoracic aorta itself; the white arrow points to blood that has exited the aorta and has entered the thorax. Hypertension is often associated with this pathology, as 70%-80% of patients with an aortic dissection have a history of hypertension. Conditions leading to cystic medial necrosis (eg, Marfan syndrome) are also associated with aortic aneurysms.

An aortic dissection is a medical emergency and is treated either with surgery or with medical management of hypertension with β-blockers and calcium channel blockers.

Major Takeaway: An aortic dissection is a medical condition that is typically characterized by severe chest pain that can radiate posteriorly. A CT of the chest or abdomen reveals a dissected aorta with a false lumen.

Read more about hypertension.

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