Aneurysm of the pulmonary artery as a cause of severe chest pain.

A 35-year-old man came to the emergency room with severe prolonged precordial chest pain. Serial chest roentgenograms obtained over a ten-year period revealed gradual development of marked aneurysmal dilatation of the pulmonary artery. Impending rupture of the artery was feared in spite of the presence of normal pulmonary artery pressure. At surgery, a markedly dilated pulmonary artery without evidence of rupture was found and the size was reduced by aneurysmorrhaphy. Prompt and continued relief of symptoms was achieved thereafter. Severe chest pain can be an initial symptom of pulmonary artery aneurysm in the absence of rupture, such pain arising either from pain receptors in the wall of the pulmonary artery or possibly from pressure on contiguous mediastinal structures.