Case: 7836058
-79 YO male
Clinical Presentation:
- Lower Abdo pain with associated nausea
- BO normal
- Improving pain post Fentanyl and Ondans
Previous History:
- L side hernia repair, reflux, L hip & knee OA
Physical Examination: -Soft non-distended Abdo
-Tender on deep palpation over RIF & RMZ
- No flank tenderness, guarding or rebound
Provisional Diagnosis: - Diverticulitis, early bowel obstruction
Imaging Performed:
CT Abdo/Pelvis C+ O-
Report Findings: - Type A Stanford dissection with extension into abdominal aorta.
- The SMA, bilateral renal arteries and IMA arise from true lumen.
- A filling defect is seen in the distal SMA
Upon visualization of an Aortic Dissection and discussion with the Radiologist, the Radiographer went on to perform a Gated Thoracic CTA
Report Findings:
-Type A Standford Dissection, extending from the aortic root, involving the thoracic and abdominal aorta. -Large mediastinal haematoma --> compression of the right main pulmonary artery
-Rupture of the false lumen of the ascending aorta contributing to large mediastinal haematoma. - Haemopericardium
- Bilateral pulmonary haemorrhage
TREATMENT:
- axillary-bifermoral graft (ax-fem fem-fem bypass)
- medicinal treatment: beta blockers
COMPLICATIONS:
- US: DVT
- MRI: Stroke, secondary and ongoing lower limb weakness. Decreased GCS
- US: R sided DVT. Initially anticoagulated, ceased due to bleeding post aortic dissection repair/ bypass. ? anticoagulation plan
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