Differential Diagnosis for AAA or Dissection Symptoms
Single Most Likely Diagnosis
- Aortic Dissection: This is a highly likely diagnosis given the symptoms of severe chest or back pain, which can be indicative of a tear in the aorta's inner layer. The pain is often described as ripping or tearing and can radiate to the back.
Other Likely Diagnoses
- Abdominal Aortic Aneurysm (AAA): Symptoms such as abdominal pain, back pain, or a palpable abdominal mass could suggest an AAA, especially in patients with risk factors like smoking, hypertension, or a family history of aneurysms.
- Pulmonary Embolism: While the primary symptom is dyspnea, severe chest pain can also be present, making it a consideration in the differential diagnosis for acute aortic syndromes.
- Myocardial Infarction: Chest pain is a hallmark symptom, and while the character and distribution may differ, it's essential to consider MI in the differential, especially given the potential for shared risk factors.
Do Not Miss Diagnoses
- Aortic Rupture: This is a medical emergency that requires immediate attention. Symptoms can include severe abdominal or back pain and can be similar to those of an AAA or dissection.
- Esophageal Rupture: Severe chest pain after vomiting or retching could indicate an esophageal rupture, a condition that is highly lethal if not promptly treated.
- Spinal Epidural Hematoma: Back pain and neurological deficits could suggest a spinal epidural hematoma, which is a neurosurgical emergency.
Rare Diagnoses
- Takayasu Arteritis: A large vessel vasculitis that can cause aortic aneurysms or dissections, particularly in younger women. Symptoms can be non-specific and include arm claudication, reduced pulses in the arms, and hypertension.
- Giant Cell Arteritis: While more commonly associated with temporal arteritis, giant cell arteritis can involve the aorta and lead to aneurysm or dissection, especially in older adults with polymyalgia rheumatica symptoms.
- Syphilitic Aortitis: A rare cause of aortic aneurysm, typically seen in the tertiary stage of syphilis. It can lead to aortic regurgitation and aneurysm formation.