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Aneurysmal Disease (Abdominal Aortic Aneurysm (Differential Diagnosis (MSK…
Aneurysmal Disease
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Characteristics
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True Aneurysm
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Arteries most frequently involved are: abdominal aorta, iliac, popliteal, femoral arteries, thoracic aorta
False Aneurysm
Involves the collection of blood in the adventitia (outer layer) only which communicates with the lumen e.g. after trauma
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Aortic Dissection
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Signs
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Sudden onset of severe and central chest pain that radiates to the back and down the arms - mimics MI
AKI, lower limb ishchaemia, visceral ischaemia due to distal extension of false lumen
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Investigations
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CT, transoesophageal echo or MRI for diagnosis
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Thoracic Aortic Aneurysm
Aetiology
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Connective tissue disorders e.g. Marfan's syndrome, Ehlers-Danlos Syndrome
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Pathophysiology
Once the aorta reaches a crucial diameter (6cm in ascending, 7cm in descending) it loses all distensibility so that a rise in BP can exceed arterial wall strength and trigger rupture
Inflammation, proteolysis and reduced survival of the smooth muscle cells in the aortic wall
Signs
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Pain in chest, neck, upper back, mid back or epigastrium
Collapse, shock, sudden death
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