This patient presents with chest pain. What’s the diagnosis?
October 14, 2013
This 32 yr old patient presents with chest pain. Based on the pictures, can you diagnose what the most likely cause is?
The cause of chest pain is Aortic dissection. This is a patient with Marfan’s Syndrome. A majority of adults with Marfan’s syndrome have aortic dilation and if untreated can lead to aortic dissection. The above pictures show a positive thumb signwhere the thumb protrudes past the lateral aspect of the hand. The second picture is referred to as a positive wrist sign where again the elongated fingers are shown as the entire nail of the index finger is covered by the thumb. This test is even more specific using the 5th digit.
A majority of adults with Marfan’s syndrome have aortic dilation and if untreated can lead to aortic dissection.
The ankle brachial index (ABI) is a common and useful exam in the outpatient setting to detect peripheral arterial disease. ABI’s should be measured in all people over the age of 50 if they are a diabetic or a smoker. It should also be checked in patients over the age of 60.
The causes of clubbing are a favourite bedside question on rounds. They can be divided into: Pulmonary (commonest – think neoplasm until proven otherwise). Bronchial carcinoma Mesothelioma Bronchiectasis Cystic fibrosis Interstitial fibrosis...