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A 50-year-old hypertensive man develops very severe, "tearing" chest pain, which migrates from his upper back
to mid-back over the period of an hour. Pathologic examination of a specimen removed from the patient during
emergency surgery would most likely demonstrate which of the following?
A. Cystic medial degeneration
B. Infarction
C. Plasma cells around the vasa vasorum
D. Severe atherosclerosis
E. Tree-barking
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A dissecting aortic aneurysm
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Explanation:
The correct answer is A. This is a classic description of a dissecting aortic aneurysm, a very important condition
that may cause death if missed or misdiagnosed. Dissecting aneurysms are actually dissecting hematomas, with
the blood located between the middle and outer thirds of the media of the aorta. Dissecting aneurysms are
associated with hypertension in many cases; they are also associated with cystic medial degeneration of the
wall of the aorta (seen in Marfan's syndrome). Often, an intimal tear is present; these are thought to represent
the starting point for the dissection. Unlike abdominal aortic aneurysm and syphilitic aneurysm, aortic dissection
is not usually associated with aortic dilatation.
The pain of myocardial infarction (choice B) does not usually move.
Plasma cells around the vasa vasorum (choice C) and "tree-barking" (wrinkling of the aortic intima; choice E )
are features of syphilitic aneurysms.
Atherosclerotic (choice D) aneurysms typically affect the abdominal aorta.
