Case 12-2004 - A 38-Year-Old Woman with Acute Onset of Pain in the Chest

doi:10.1056/NEJMcpc049004

Volume 350:1666-1674		April 15, 2004		Number 16

Case 12-2004 — A 38-Year-Old Woman with Acute Onset of Pain in the Chest

Patrick T. O'Gara, M.D., Alan J. Greenfield, M.D., Nadeem A. Afridi, M.D., and Stuart L. Houser, M.D.

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Presentation of Case

A 38-year-old woman was admitted to the hospital because ofthe acute onset of pain in the chest and upper back.

Two weeks before admission, the patient had given birth by cesareansection at eight and a half months' gestation to a healthy femaleinfant. Early in the pregnancy, the patient had experiencedchest pain. A cardiac ultrasonographic examination revealedmild aortic regurgitation, and the result of a cardiac stresstest was normal. At that time, she was gravida 11, para 3, havinghad seven first-trimester miscarriages. The delivery was complicatedby loss of blood and a drop in the . . . [Full Text of this Article]

Differential Diagnosis

Acute Aortic Syndromes

Aortic Dissection

Pregnancy and Aortic Dissection

Aortic Intramural Hematoma

Penetrating Aortic Ulcer

Expansion of an Aortic Aneurysm

Diagnostic Strategy

Summary

Clinical Diagnosis

Dr. Patrick T. O'Gara's Diagnosis

Pathological Discussion

Anatomical Diagnosis

Source Information

From the Cardiovascular Division, Brigham and Women's Hospital (P.T.O.); the Departments of Radiology (A.J.G.) and Pathology (S.L.H.) and the Cardiology Division (N.A.A.), Massachusetts General Hospital; and the Departments of Medicine (P.T.O., N.A.A.), Radiology (A.J.G.), and Pathology (S.L.H.), Harvard Medical School — all in Boston.