Aortic Dissection and Aneurysm

Question 1

A 45 year old office executive present to the ED with complaints of a sharp tearing chest pain that radiates to the back. What is this? Where does it usually occur?

Answer 1

Aortic dissection leading to intimal tear with dissection of blood through media of the aortic wall. Occurs in the proximal 10 cm of the aorta (high stress region) with preexisiting weakness of the media.

Question 2

What is the most common cause of aortic dissection in older adults? How does it cause the damage?

Answer 2

Hypertension which results in hyaline arteriolosclerosis of teh vasa vasorum. Decreased flow causes atrophy of the media.

Question 3

What is the most common cause of aortic dissection in younger individuals? How does it cause the damage?

Answer 3

Inherited defects of connective tissue. Marfan syndrome and Ehler-Danos syndrome which lead to weakness of the connective tissue in the media (cystic medial necrosis)

Question 4

What are the three complications of aortic dissection?

Answer 4

Pericardial tamponade, rupture with fatal hemorrhage, obstruction of branching arteries with resultant end organ ischemia

Question 5

What causes thoracic aneurysm? What disease is it usually seen in? What does the aorta look like?

Answer 5

Weakness of the aortic wall. Classically seen in tertiary syphilis. Endarteritis of the vasa vasorum results in luminal narrowing, decreased flow and atrophy of the vessel wall. Results in a tree-bark appearance of the aorta

Question 6

What is a major complication of a thoracic aneurysm?

Answer 6

Dilation of the aortic valve root resulting in aortic valve insufficiency. Other complications include compression of mediastinal structures and thrombosis/embolism

Question 7

What is a major complication of a thoracic aneurysm?

Answer 7

Dilation of the aortic valve root resulting in aortic valve insufficiency. Other complications include compression of mediastinal structures and thrombosis/embolism

Question 8

A 65 year old patient with a a history of hypertension and smoking comes to the clinic with a pulsatile abdominal mass. What is causing this? Where does this usually occur? What are some complications?

Answer 8

Abdominal aortic aneurysm which arises below the renal arteries and above the aortic bifurcation. Primarily due to atherosclerosis which increases the diffusion barrier to the media resulting in atrophy and weakness of the vessel wall. Major complication is rupture.

Question 9

A 65 year old patient with a a history of hypertension and smoking comes to the clinic with a pulsatile abdominal mass, hypotension and flank pain. What is causing this presentation?

Answer 9

Rupture of Abdominal aortic aneurysm especially when > 5 cm in diameter. Other complications include compression of local structures (ureter) and thrombosis/embolism.