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April 18, 2024

A 68-year-old male with a history of uncontrolled hypertension presents to the emergency department with chest pain after a motor vehicle accident. He describes the chest pain as a tearing sensation that radiates to his back. Vital signs reveal a widened pulse pressure with significantly different readings between arms. Chest x-ray reveals a widened mediastinum. Which of the following tests is the gold standard for confirming the most likely diagnosis?

Correct Answer: 

D. CT angiography

Explanation:

This patient with a history of uncontrolled hypertension is likely presenting with an aortic dissection secondary to a motor vehicle accident. Patients may present with tearing chest pain and asymmetric blood pressure readings between arms depending on the location of the tear. This patient also had a widened mediastinum on chest x-ray due to widening of the aorta. The gold standard for diagnosing aortic dissection is to perform a CT angiography since it is highly sensitive and specific for this condition. MRA is also very reliable but it is not time efficient (choice E).

Quick Concepts:

Aortic dissection gold standard for diagnosis
– CT angiography

Summary:

CTA is the gold standard for diagnosing aortic dissection.

Explanation:



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