Board Review

Still Too Scary a Case to be Bored Review

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To continue discussing the chest pain patient from last week…(you remember, the syphilitic patient with Turner Syndrome who presents with tearing chest and epigastric pain radiating to the back with unequal upper extremity blood pressures, a pulseless leg, neurologic deficits)

 

What Chest X-Ray findings can you see here?

1. Large mediastinum

2. Blurred aortic knob

3. Left sided pleural effusion

4. Enlarged thoracic aorta compared with previous

5. “eggshell” sign – enlarged aortic shadow outside of calcified aortic wall

6. Aorta with two different densities

7. Deviation of trachea or depressed left mainstem bronchus

 

How are aortic dissections classified?

DeBakey: Type 1 – Ascending and Descending aorta

Type 2 – Ascending aorta only

Type 3 – Descending aorta only

Stanford:  Type A – Ascending aorta only

Type B – Descending aorta only

 

Diagnose Aortic Dissection?
We use CTA of the thoracic aorta…be careful for outdated/weird board review facts – Rivers recommends TEE as the primary diagnostic test…which sounds crazy

 

Aortic Dissection Treatment?
blood pressure control (esmolol) for all, type and crossed for 10 to 15 units, surgery if Ascending Aortic Dissection (Stanford A or Debakey type 2

 

 

By Dr. Andrew Grock and Dr. Sally Bogoch

 

 

References

 

Rivers

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The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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andygrock

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