Question

A patient presents with sudden onset of chest pain shooting to the neck and interscapularregion. X-ray shows widened mediastinum. BP is 110/90 mmHg in the right upper limb and 160/100 mmHg in the left upper limb. What is the most likely diagnosis?

• A. Acute coronary syndrome
• B. Acute pulmonary embolism
• C. Acute aortic dissection
• D. Esophageal rupture

Answer 1

The Correct Option is C

A patient arrives with a sudden onset of chest pain radiating to the neck and interscapular region, and an X-ray reveals a widened mediastinum. Additionally, there is a noted blood pressure difference between the limbs: 110/90 mmHg in the right upper limb and 160/100 mmHg in the left upper limb.

Given these symptoms, we analyze each option:

• Acute coronary syndrome: Typically presents with chest pain but does not explain the widened mediastinum or blood pressure discrepancy between limbs.
• Acute pulmonary embolism: May cause acute chest pain and respiratory symptoms but usually does not cause mediastinal widening or BP differences.
• Acute aortic dissection: Characterized by severe chest pain radiating to the back, sudden onset, a widened mediastinum due to aortic involvement, and differing blood pressures in the limbs due to disrupted blood flow.
• Esophageal rupture: Can present with sudden pain and mediastinal issues but is less likely to cause such significant BP discrepancies.

Conclusion: The symptoms and the X-ray findings of the widened mediastinum, along with the blood pressure discrepancy between the extremities, strongly point to Acute aortic dissection as the most likely diagnosis.