Painless Dissecting Aneurysm of the Aorta

W ITH the development of successful surgical treatment of dissecting aortic aneurysm," 2 accurate diagnosis of this condition has become increasingly important. Pain in the torso, usually in the chest or back, is considered to be a classical feature of dissecting aneurysm of the aorta, but reliance on the presence of pain may result in unnecessary delay in diagnosis and treatment. Without treatment, approximately 25 per cent of patients survive the acute aortic dissection for more than 2 weeks, and approximately 10 per cent live for more than 6 months.3 Although dissecting aneurysm occurs most commonly in the sixth and seventh decades of life and is known to be associated with abnormal cardiovascular conditions, such as the Marfan syndrome, hypertension, and coarctation of the aorta, it may also occur in young adults with otherwise normal cardiovascular systems 4 and in pregnant women.5 The present report was prompted by experience with a patient who had a painless dissecting aneurysm of the aorta and who exhibited certain features that allowed the correct clinical diagnosis to be made in the absence of pain in the torso.