Explore this issueMay 2014
A 27-year-old Caucasian woman previously in good health presented to the emergency department (ED) with three months of progressive fatigue, shortness of breath, paroxysmal nocturnal dyspnea and orthopnea. She also described left flank pain, left frontal neck and upper back pain, left arm claudication and frequent left-side headaches. She had an episode of complete loss of vision in her left eye lasting a few seconds three months prior to admission, but she did not seek medical attention at the time. Her progressive shortness of breath prompted her ED visit.
A chest computed tomography (CT) scan was performed to evaluate for a pulmonary embolus, but instead it revealed dilation of the ascending aorta and a 3.9 cm wide fusiform aneurysm of the descending thoracic aorta. Her blood pressure was 98/49 mmHg in her right arm, 88/36 mmHg in her left arm, 133/26 and 135/26 mmHg in her right and left legs. Her physical exam was significant for a IV/VI diastolic murmur loudest at the right upper sternal border, a barely palpable left carotid pulse, and weak left axillary, brachial and radial pulses. The rest of her vascular exam was normal.