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Diagnostic Images, Treatment Decisions

Diagnostic Images, Treatment Decisions

Case 1:Middle-aged Man With Chest PainFor 3 days, a 42-year-old man has had episodic dull
chest pain. The anterior precordial and retrosternal
pain intensifies with inspiration and movement. He has no
history of recent viral infection, hypertension, coronary
artery disease, cardiac surgery, diabetes mellitus, or hyperlipidemia.
There is no family history of cardiovascular

The patient denies risk factors for HIV infection. He
takes no medications or herbal remedies and does not use
illicit drugs.

In the emergency department, the patient is alert but
uncomfortable. Blood pressure is 160/102 mm Hg in all
extremities; heart rate, 103 beats per minute, regular and
equal bilaterally. There is a faint early diastolic murmur
in the aortic region; no gallop, pericardial rub, or knock is
audible. The lungs are clear; abdominal findings are unremarkable.
The cranial nerves are intact; no neurologic
deficits are found.

Serial measurement of cardiac isoenzymes reveals
no evidence of myocardial injury. The patient's ECG and
chest film are shown here.

What abnormalities are evident on these studies--
and to what diagnosis do they point?

A. Acute coronary syndrome
B. Acute pericarditis
C. Aortic dissection
D. Ventricular aneurysm
E. Aneurysm of the thoracic aorta


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