Thoracic Aortic Aneurysm

Main parameter: sudden onset (intact aneurysm usually asymptomatic)
  • Pain is “sharp,” “tearing” or “ripping,” as opposed to the dull, heavy ache of coronary disease.
  • May radiate to the back or anywhere, or remain in the chest.
Work up such patients >60 with cardiovascular risks.  Younger patients if:
  • Marfan’s syndrome
  • Congenital bicuspid aortic valves.
Chest x-ray:
  • Wide mediastinum or tracheal deviation
  • Normal up to 1/3 of the time.

Bottom line: sudden onset of severe sharp or tearing chest pain in a patient at risk warrants CT in the ED.

See posting Chest Pain – 3.

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