title: An uncommon cause of chest pain - penetrating atherosclerotic aortic ulcer.
abstract: Chest pain is a very common symptom and can be of cardiac or non-cardiac origin. It accounts for approximately 5.5 million annual emergency room visits in the United States, according to 2011 CDC data. Penetrating atherosclerotic aortic ulcer (PAU), an uncommon condition, is also a potential cause of chest pain. We here report the case of a 65-year-old woman who presented with atypical chest and back pain. The pain persisted for 4 weeks necessitating two emergency room visits. Initial tests were non-significant including cardiac troponins, an electrocardiogram (EKG), and a chest X-ray on her first visit. Upon her second visit, she underwent a computed tomography angiogram of chest with contrast which revealed a PAU with an intramural hematoma in descending aorta. The PAU was finally diagnosed with an exclusion of other chest pain causes. She was treated non-surgically with a blood pressure control strategy and pain management. After a 2-month period of smoking cessation and following the achievement of a controlled blood pressure, she felt well without chest pain.
authors.affiliation: Department of Internal Medicine, The Brooklyn Hospital Center, Academic Affiliate of the Icahn School of Medicine at Mount Sinai, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA; htookyaw2007@gmail.com.
authors.forename: Htoo
authors.initials: H
authors.lastname: Kyaw
authors.affiliation: Department of Internal Medicine, The Brooklyn Hospital Center, Academic Affiliate of the Icahn School of Medicine at Mount Sinai, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA.
authors.forename: Sanah
authors.initials: S
authors.lastname: Sadiq
authors.affiliation: Department of Internal Medicine, The Brooklyn Hospital Center, Academic Affiliate of the Icahn School of Medicine at Mount Sinai, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA.
authors.forename: Arnab
authors.initials: A
authors.lastname: Chowdhury
authors.affiliation: Department of Internal Medicine, The Brooklyn Hospital Center, Academic Affiliate of the Icahn School of Medicine at Mount Sinai, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA.
authors.forename: Rashin
authors.initials: R
authors.lastname: Gholamrezaee
authors.affiliation: Department of Internal Medicine, The Brooklyn Hospital Center, Academic Affiliate of the Icahn School of Medicine at Mount Sinai, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA.
authors.forename: Linus
authors.initials: L
authors.lastname: Yoe
keywords: chest pain; hypertension; ischemic heart disease; penetrating atherosclerotic aortic ulcers; smoking and tobacco