A 45-year-old man with a history of smoking and hypertension develops sudden severe tearing chest pain radiating to the back. CT angiography reveals a dissection flap in the ascending aorta extending to the aortic arch. Which underlying pathology is most commonly associated with this condition?
- A Atherosclerosis of the aortic intima
- B Cystic medial necrosis (cystic medial degeneration) ✓
- C Syphilitic aortitis
- D Giant cell aortitis
Correct answer: B. Cystic medial necrosis (cystic medial degeneration)
Explanation
Cystic medial degeneration (cystic medial necrosis) is the most common histologic abnormality predisposing to aortic dissection, characterized by smooth muscle cell necrosis and mucoid material accumulation in the media. Hypertension is the major risk factor. While associated with Marfan syndrome, it also occurs in isolated hypertension without connective tissue disease. Syphilitic aortitis causes aortic aneurysms, not dissection. Robbins 10th ed, Chapter 11.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.