A 42 year old man with acute chest pain: case outcome

doi:10.1136/bmj.326.7399.1133

BMJ 2003;326:1133 (24 May), doi:10.1136/bmj.326.7399.1133

Clinical review

Interactive case report

A 42 year old man with acute chest pain: case outcome

G Sodeck, registrar¹, B Partik, consultant², H Domanovits, consultant¹

¹ Department of Emergency Medicine, Vienna General Hospital, Währinger Gürtel 18-20, A-1093 Vienna, Austria, ² Department of Radiology, Vienna General Hospital

Correspondence to: H Domanovits hans.domanovits@akh-wien.ac.at

The first 150 words of the full text of this article appear below.

Three weeks ago (26 April, p 920), we presented the case ofPeter Hartl, a 42 year old man who presented to his local emergencydepartment with severe retrosternal chest pain. Initial investigationruled out myocardial ischaemia (3 May, p 974). He had spiralcomputed tomography to exclude a pulmonary embolus becauseof his persistent dyspnoea and suggestive findings on echocardiographyand chest radiography. To our surprise, this showed an aneurysmof the ascending aorta (6 cm in diameter) with a dissectingmembrane. The aneurysm originated at the aortic root and led into the brachio-cephalic trunk and left common iliac artery(fig 1, 2).

Fig 1 Spiral computed tomogramof thorax showing aneurysmatic widening of aortic arch withdissecting membrane. Note the different specification of trueand false lumen

Fig 2 Spiral computed tomogramof thorax showing dissecting membrane in aneurysmatic ascendingand descending aorta

He was given intravenous urapidil . . . [Full text of this article]

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