Aneurysms

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A 35-year-old man comes to the emergency department with a one day history of dull chest pain. The patient reports he was out for a jog yesterday when he suddenly experienced dull chest pain radiating to the back, with associated shortness of breath. The patient reports he is otherwise healthy but has smoked 5-10 cigarettes per day for the past ten years. His temperature is 37.0°C (98.6°F), pulse is 78/min, respirations are 18/min, blood pressure is 130/66 mmHg, and O2 saturation is 99% on room air. He does not appear to be in acute distress. Physical examination shows a thin, tall man, with a concave anterior chest wall. Cardiovascular examination shows 2+ pulses in the upper extremities bilaterally, and a mid-systolic murmur at the cardiac apex is heard on auscultation. Which of the following is the most likely diagnosis?  

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ADPKD (Autosomal dominant polycystic kidney disease)

saccular aneurysms and p. 533

Aneurysms p. 533

atherosclerosis p. 308

coarctation of aorta p. 305

Ehlers-Danlos syndrome and p. 49

superior vena cava syndrome p. 710

ventricular p. 311, 316

Aorta

aneurysm of p. 308

Atherosclerosis p. 308

abdominal aortic aneurysms and p. 308

aortic aneurysms p. 728

Bicuspid aortic valve

thoracic aortic aneurysms and p. 308

“Blown pupil p. 561

saccular aneurysms p. 533

Circle of Willis p. 519

saccular aneurysms p. 533

Connective tissue diseases

thoracic aortic aneurysms and p. 308

Coronary aneurysms p. 717

Ehlers-Danlos syndrome p. 49

aneurysm association with p. 533

Hemiparesis p. 541

saccular aneurysms p. 533

Hypertension p. 306

Charcot-Bouchard microaneurysms p. 533

thoracic aortic aneurysms and p. 308

Marfan syndrome

aortic aneurysms p. 728

thoracic aortic aneurysms and p. 308

Middle cerebral artery (MCA)

saccular aneurysms p. 533

Saccular aneurysms p. 533

Ehlers-Danlos syndrome p. 49

renal cyst disorders and p. 630

Smoking

abdominal aortic aneurysms and p. 308

saccular aneurysms p. 533

Syphilis p. 145

thoracic aortic aneurysms and p. 308

Tertiary syphilis

aortic aneurysms p. 728

Visual field defects p. 562

saccular aneurysms and p. 533

Transcript

Content Reviewers

The word “aneurysm” comes from the Greek word aneurysma, meaning “dilation.” This makes sense because aneurysms are defined as abnormal dilations in a blood vessel. A bulge in a blood vessel is officially labelled as an aneurysm when the diameter of the bulge is approximately one and a half times larger than the normal diameter of the blood vessel.

Aneurysms can happen to any blood vessel in your body, including the aorta, the femoral artery, the iliac artery, the popliteal artery, and the cerebral arteries. They can also happen in your veins too, but those are less common as blood pressure in veins is much, much lower than in the arteries.

There are two major categories of aneurysms: true aneurysms and pseudoaneurysms. In true aneurysms, all the layers of the blood vessel wall dilate together. True aneurysms that balloon out symmetrically on all sides of the blood vessel are called fusiform aneurysms, whereas asymmetrically shaped aneurysms balloon out on one side of the blood vessel. This asymmetrical shape usually happens because for some reason one side of the blood vessel wall experiences higher blood pressure than the rest of the vessel wall, or because the wall was weaker on one side to begin with. Asymmetrical true aneurysms can be called either “saccular” or “berry” aneurysms.

Pseudoaneurysms, on the other hand, are like false aneurysms because they are not actually aneurysms at all. They are caused by a small hole in your blood vessel which allows blood to leak out of the vessel and form a pool of blood that looks like a fusiform or berry aneurysm depending on where the hole is and its size. The blood pools because the surrounding tissues act as walls that contain the blood in one spot.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "Aneurysms in Vascular Access: State of the Art and Future Developments" The Journal of Vascular Access (2017)
  5. "Open and Endovascular Management of Aortic Aneurysms" Circulation Research (2019)
  6. "Abdominal aortic aneurysms" Current Opinion in Cardiology (1994)
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