A 62-year-old hypertensive man with a 40-pack-year smoking history presents with sudden-onset severe substernal chest pain radiating to the back. Vital signs show BP 168/95 mmHg, HR 102 bpm, RR 18/min, and normal oxygen saturation. Physical examination reveals a 20 mmHg systolic blood pressure differential between arms and no focal neurological deficits. CTA chest demonstrates a linear intimal flap within the descending thoracic aorta. Which of the following is the most likely diagnosis?
- A)Acute myocardial infarction
- B)Tension pneumothorax
- C)Esophageal rupture
- D)Acute aortic dissectionGABARITO
- E)Pulmonary embolism
Explicação
Aortic dissection presents with sudden severe tearing chest/back pain, hypertension, pulse differential, and blood pressure differential between limbs. The combination of sudden onset, radiation to the back, and asymmetric pulses is pathognomonic. Ver explicação completa e trilha adaptativa →