the pulsatile mass gave it away for me but looking back this patient has all the risk factors for AA - male smoker with HTN + deep chest pain and pulsatile mass = AA all day long
mcdumbassAdding on, hoarseness + difficulty swallowing means something is pushing on the recurrent laryngeal.
Murmur in the second right intercostal space = AR, AS, or Pulm regurg --> AR associated with thoracic aortic aneurysm, or at minimum, you can infer it's a cardiac etiology+4
chadgasThe dyspnea, dysphagia, stridor, and cough are pretty indicative of a mediastinal mass. So expansion of the aorta can cause compression of the esophagus, trachea, recurrent laryngeal nerve, etc. depending on the severity of it.+1
Can someone explain how they r/o aortic stenosis? because that could enlarge the LA and give the same sx of hoarseness etc. And the murmur also fits with AS
bmalametYou would not see a "viable pulsation above the manubrium, which you should not confuse with a "brisk carotid upstroke" associated with aortic stenosis. +2
nbmeanswersownersucks"brisk carotid upstroke" is the description of a normal carotid pulse. Aortic stenosis has a slowly rising/late peaking upstroke since the stenosis impedes flow out of the LV. +9
overaAS affects the LV first. it isn't until later in the disease progression that there will be a significant enough enlargement of the LA to cause impingement of the LA. By the time the problem was that bad there would also be pulmonary findings of backed-up pressure (in my not so expert opinion).+
305charlie94Can anyone explain why the trachea is deviated in an aortic aneurysm? Made me think of a pneumothorax here+3
submitted by โmousie(272)
the pulsatile mass gave it away for me but looking back this patient has all the risk factors for AA - male smoker with HTN + deep chest pain and pulsatile mass = AA all day long