With untreated hypertension, which condition would you suspect given chest/back pain and dysphagia?

With untreated hypertension, which condition would you suspect given chest/back pain and dysphagia?

• A. Pneumonia
• B. Esophageal cancer
• C. Thoracic aortic aneurysm
• D. Abdominal aortic aneurysm

Answer: (C)

Hypertension predisposes to thoracic aortic aneurysm, and when the aneurysm enlarges in the mediastinum it can press on nearby structures, including the esophagus. That can cause dysphagia, while the expanding vessel or a related dissection can produce chest and back pain. This combination—chest/back pain with swallowing trouble—in a patient with untreated hypertension points most strongly to a thoracic aortic aneurysm (sometimes called dysphagia aortica when the esophagus is involved). Other options don’t fit as well: pneumonia brings infection signs rather than progressive mediastinal compression; esophageal cancer can cause dysphagia but isn’t tied to hypertension or chest/back pain from a vascular process; an abdominal aortic aneurysm causes abdominal or back pain and wouldn’t explain dysphagia.

Hypertension predisposes to thoracic aortic aneurysm, and when the aneurysm enlarges in the mediastinum it can press on nearby structures, including the esophagus. That can cause dysphagia, while the expanding vessel or a related dissection can produce chest and back pain. This combination—chest/back pain with swallowing trouble—in a patient with untreated hypertension points most strongly to a thoracic aortic aneurysm (sometimes called dysphagia aortica when the esophagus is involved). Other options don’t fit as well: pneumonia brings infection signs rather than progressive mediastinal compression; esophageal cancer can cause dysphagia but isn’t tied to hypertension or chest/back pain from a vascular process; an abdominal aortic aneurysm causes abdominal or back pain and wouldn’t explain dysphagia.