[Subacute thoracic pain].
A 75-year old woman with essential hypertension presented two days after the onset of a sudden and strong thoracic pain. The pain did neither increase during breathing nor decrease after the ingestion of nitroglycerine, and could not be triggered by physical manipulation of the thoracic wall. Electrocardiogram showed a left bundle branch block, chest X-ray showed a widened upper mediastinum. Rupture/dissection of an aberrant right subclavian artery (a. lusoria) could be diagnosed by computed tomography. Successful implantation of an endovascular stent-graft was carried out. Evaluation of (sub)acute thoracic pain should include two-plane chest X-ray and, in case of a widened mediastinum, further investigation by computed tomography. In case of highly suspected rupture/dissection of an intrathoracic artery, a specific imaging procedure such as computed tomography is crucial.
Grob
U
U
Medizinische Poliklinik, Departement für Innere Medizin, Universitätsspital Zürich.
Lachat
M
M
Pfammatter
Th
T
Krayenbühl
P
P
Käser
L
L
Schulthess
G
G
D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis* / Q000628:therapy; D017542:Aneurysm, Ruptured / Q000175:diagnosis* / Q000628:therapy; D000800:Angioplasty, Balloon; D002037:Bundle-Branch Block / Q000175:diagnosis; D002637:Chest Pain / Q000209:etiology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015607:Stents; D013348:Subclavian Artery / Q000002:abnormalities; D014057:Tomography, X-Ray Computed