Question

59 year old man with 2hr vague chest discomfort. Started suddenly while watching TV. No other Sx. BP controlled by thiazides. 30 pack per year smoker. Lear lungs and normal heart sounds. ECG normal. First set of cardiac enzymes normal. chest x-ray provided

-CXR showed tracheal deviation, enlarged aortic knob, widened mediastinum and widened aorta.
-Thoracic aortic aneurysm (Degenerative aortic disease)

Answer 1

A 59-year-old man's chest X-ray showing signs of a thoracic aortic aneurysm indicates a serious condition potentially linked to his smoking history and necessitates immediate medical attention.

Step-by-step explanation:

The symptoms presented by the 59-year-old man, including chest discomfort with no other symptoms, controlled blood pressure, smoking history, and an unremarkable initial ECG and cardiac enzymes, coincide with a cardiopulmonary issue. However, a chest X-ray (CXR) provides critical information, revealing tracheal deviation, an enlarged aortic knob, a widened mediastinum, and a widened aorta, suggesting a thoracic aortic aneurysm due to degenerative aortic disease. This is a serious condition that requires immediate medical attention, often surgical intervention, as it can lead to life-threatening complications such as aortic dissection or rupture. Smoking is a known risk factor for aortic aneurysms, as highlighted by the SURGEON GENERAL'S WARNING indicating the link between smoking and various diseases including heart disease.