MEDizzy - A 60-year-old woman with a history of hypertension presents

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Cardiovascular System

A 60-year-old woman with a history of hypertension presents with the sudden onset of excruciating pain beginning in the anterior chest, radiating to the back, and moving downward into the abdomen. Her blood pressure is found to be 160/115. An angiogram of this patient’s abdomen reveals a “double barrel” aorta. What is the most likely diagnosis?

ExplanationAn angiogram that shows a “double barrel” aorta is diagnostic of a dissecting aortic aneurysm. This “double barrel” pattern results from blood dissecting into the wall of the aorta and creating a second false lumen in addition to the original true lumen of the aorta. Dissecting aortic aneurysms are usually the result of cystic medial necrosis of the aorta. This abnormality results from loss of elastic tissue in the media and is associated with hypertension and Marfan syndrome. Most cases of dissecting aneurysms involve a transverse tear in the intima and are located in the ascending aorta, just above the aortic ring. The pain caused by a dissecting aneurysm is similar to the pain caused by a myocardial infarction, but it extends into the abdomen as the dissection progresses. Additionally, the blood pressure is not decreased with a dissecting aneurysm unless the aorta itself has ruptured.