Aneurysms

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Aneurysms

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Preguntas

Preguntas del estilo USMLE Step 1

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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?  

External References

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ADPKD (Autosomal dominant polycystic kidney disease)

saccular aneurysms and p. 529

Aneurysms p. 529

atherosclerosis p. 305

coarctation of aorta p. 303

Ehlers-Danlos syndrome and p. 49

superior vena cava syndrome p. 704

ventricular p. 309, 314

Aorta

aneurysm of p. 305

Atherosclerosis p. 305

abdominal aortic aneurysms and p. 305

aortic aneurysms p. 731

Bicuspid aortic valve

thoracic aortic aneurysms and p. 305

“Blown pupil p. 556

saccular aneurysms p. 529

Circle of Willis p. 514

saccular aneurysms p. 529

Connective tissue diseases

thoracic aortic aneurysms and p. 305

Coronary aneurysms p. 723

Ehlers-Danlos syndrome p. 49

aneurysm association with p. 529

Hemiparesis p. 537

saccular aneurysms p. 529

Hypertension p. 304

Charcot-Bouchard microaneurysms p. 529

thoracic aortic aneurysms and p. 305

Marfan syndrome

aortic aneurysms p. 731

thoracic aortic aneurysms and p. 305

Middle cerebral artery (MCA)

saccular aneurysms p. 529

Saccular aneurysms p. 529

Ehlers-Danlos syndrome p. 49

renal cyst disorders and p. NaN

Smoking

abdominal aortic aneurysms and p. 305

saccular aneurysms p. 529

Syphilis p. 145

thoracic aortic aneurysms and p. 305

Tertiary syphilis

aortic aneurysms p. 731

Visual field defects p. 557

saccular aneurysms and p. 529

Transcript

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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.

Arterial aneurysms occur most commonly in the aorta with about 60% of true aortic aneurysms happening in the abdominal section of the aorta, and the other 40% happening in the thoracic section. Of all the abdominal aortic aneurysms, you can find about 95% of them just below the point where the renal arteries branch off from the abdominal aorta but above the aortic bifurcation. This is because there is naturally less elastin[a] in the walls of this section of the aorta.

Fuentes

  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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