A 54-year-old man complains of sudden onset of severe chest tearing pain. The pain started an hour ago and radiating to his upper back. On physical examination, his pulse is 90/min., his blood pressure in his left arm is 140/90 while it is 110/70 in his right arm. Chest x-ray shows widening of the mediastinum.

What is the most likely pathological finding of this condition?

A- Liquefactive necrosis of the myocardium

B- Accumulation of fluid in the pericardial sac

C- Separation of layers of the aortic wall

D- Plaque rupture and erosion in the left coronary artery

E- Aneurysm of the right coronary artery


This condition is most likely aortic dissection suggested by the history and clinical examination and confirmed by radiology. Separation of the layers of the aortic wall due to tears in the intimal layer and blood rushing into the intima-media space is the main pathological finding at this stage. Other choices are the pathological findings of other medical conditions not included in the above scenario.

The correct answer is C