Advanced, recurrent mesothelioma growth mimicking an aortic dissection
BMJ Case Reports, 2011, bcr0920103319 · 2011 · doi:10.1136/bcr.09.2010.3319
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Plain-language summary
A case report of a patient with known mesothelioma (an aggressive cancer usually linked to asbestos exposure) who presented to the emergency department with chest pain and unequal blood pressure readings in each arm — a textbook warning sign of a life-threatening aortic dissection. Imaging instead revealed that the tumour itself had grown to compress the major blood vessels, mimicking a dissection.
Why this matters
When a patient presents with unequal arm blood pressures, clinicians are trained to think dissection first. This case is a reminder that other serious pathology can produce an identical clinical picture, and that imaging — rather than pattern recognition alone — should guide urgent management decisions.
Published abstract
In the emergency setting, a cold, clammy, dyspnoeic patient presenting with interscapular chest pain and unequal blood pressures suggests an acute aortic dissection until proven otherwise. By means of a case report, the authors detail one such patient who presented identically to one having an acute aortic dissection. Initial assessment showed unequal blood pressures in left and right arms, a resting tachycardia and indistinct heart sounds. Fluid resuscitation failed to improve the patient's physiological parameters and they rapidly deteriorated. The medical history included mesothelioma and atrial fibrillation. Existing investigations were reviewed and, after thorough consideration of the patient's premorbid state and likely prognosis, the decision was made to palliate. Imaging is therefore integral to the assessment and management of a patient in whom an aortic dissection is feared.
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Keywords
mesothelioma aortic dissection chest pain case report emergency imaging
Cite this publication
Pankhania M, Hardiment K, Marathe M. Advanced, recurrent mesothelioma growth mimicking an aortic dissection. BMJ Case Reports. 2011;2011:bcr0920103319. doi:10.1136/bcr.09.2010.3319Copied!