1.widened mediastinum
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This chest x-ray shows a widened mediastinum in a 72-year-old man with hypertension, hyperlipidemia, and ischemic heart disease who presented with chest and back pain and coughing. He was diagnosed with a leaking dissecting aortic aneurysm. The patient should undergo a contrast-enhanced CT scan for further evaluation and potentially be referred to a center with vascular surgery if needing an operation. In the meantime at the district hospital, his blood pressure and pain should be managed, urine output monitored, pulses checked, IV access established, and blood crossed matched in case of emergency surgery.
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This document summarizes the case of a 46-year-old man who presented with chest pain and cough. His chest examination and X-ray showed an enlarged mediastinum. Differential diagnoses for the cause of the mediastinal mass include Hodgkin's lymphoma, non-Hodgkin's lymphoma, thyroid mass, teratoma, and tumors of the thymus. Advanced imaging such as CT scan or MRI would help differentiate the origin of the mass and diagnostic radiological intervention such as biopsy may be needed.
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Upper extremity arterial disease
Upper extremity arterial disease can be caused by large vessel occlusive diseases like atherosclerosis or embolism, or small vessel diseases like autoimmune disorders. Symptoms range from Raynaud's phenomenon to acute ischemia with pain and pallor. Evaluation involves vascular exams, imaging like ultrasound and angiography. Treatment depends on severity and includes medications for vasospasm, endovascular interventions for stenoses, or open surgery for severe occlusions.
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However, it is an invasive procedure that is not straightforward to perform so is often reserved as a problem-solving tool when both the aortic root and valve are the prime source of interest.
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Acute aortic syndrome, which includes aortic dissection, is a silent killer that is often misdiagnosed due to its variable presentation and difficulty detecting by exam alone. It has a high mortality rate of about 1-2% per hour for the first 48 hours if left untreated. While most common in males over age 60 with hypertension, it can affect anyone and requires a high index of suspicion. For type A dissections, surgery is usually required while type B can be treated medically or with newer endovascular techniques which are less invasive than open surgery. Proper patient selection and anatomy are important considerations for endovascular treatment which aims to seal the dissection flap and promote positive aortic remodeling.
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An aortic dissection is a tear within the layers of the aortic wall. It can cause severe chest or back pain and risks damage to organs if blood flow is blocked. Prompt diagnosis through imaging tests and treatment are critical to survival. While type A dissections involving the ascending aorta require emergency surgery, type B dissections of the descending aorta can often be treated through intensive blood pressure control and medication to prevent expansion of the tear. Risk factors include hypertension, genetics, trauma, and certain medical conditions.
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Type B aortic dissection occurs when blood flows within the aortic wall separating the layers of the media. Computed tomography angiography is useful for establishing the diagnosis by showing two distinct lumens separated by an intimal flap, and for determining the location of the primary intimal tear and extent of dissection. Initial medical management aims to control blood pressure and pain. Intervention may be indicated for complications such as persistent pain, expansion of the dissection, or impaired blood flow to organs. Both open surgical repair and endovascular techniques can be used to treat type B dissection, with endovascular options becoming more common due to lower risks.
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This document discusses aortic dissection, including:
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2. It covers the incidence, risk factors, classifications, pathogenesis, natural history, signs and symptoms, diagnostic testing including imaging and labs, and management approaches for aortic dissection.
3. The management focuses on reducing blood pressure and pulse pressure through beta blockers and other antihypertensive drugs to prevent extension of the dissection.
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Acute Aortic Syndromes: Vascular Radiologist Point of View - Pr Ph Douek
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A&e end posting osce assesment group 7
The document contains sample questions and answers for an OSCE (Objective Structured Clinical Examination) assessment in accident and emergency settings. It includes sample cases and imaging for pediatric resuscitation, medical emergencies, trauma, and orthopedic injuries. For each case, it lists questions to assess indication, diagnosis, management, and complications. The responses provide concise answers addressing the prompts for each case scenario.
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Although doctors took oath that they will treat everyone the best they can and without judging anyone but discrimination still exist especially in HIV affected people. Due to this issue, Pertubuhan Advokasi Masyarakat Terpinggir Malaysia has taken a step to engage with doctors at government sector and desensitize them and find the line to stand together.
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A 45-year-old man presented to the emergency department with severe chest pain radiating to his back for 2 hours. His vital signs showed elevated blood pressure and absent radial pulses. An ECG showed sinus tachycardia but no signs of ischemia. A chest x-ray revealed a widened mediastinum. He was initially stabilized and transferred to the CCU for further investigation and management, which may include aortic dissection. Aortic dissection involves a tear in the inner layer of the aorta allowing blood to flow between the layers, and can be classified and treated in different ways depending on its location and severity.
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1.widened mediastinum
- 1. Image of the Day 1: Widened Mediastinum Muhamad Na’im B. Ab Razak (MD USM) This is a Chext X Ray finding belongs to a 72 years old male with known case of hypertension, hyperlipidaemia and Ischemic heart disease who presented with left sided chest pain radiating to the back and cough. The Chest X ray findings shows widened mediastinum with blunting of left costophrenic angle. A Diagnosis of Leaking Dissecting Aortic Aneurysm was made. At this point, the patient should undergo further radiological evaluation. At this point, contrasted enhanced CT scan should be performed. If patient to undergo operation, therefore, he should be referred to center with vascular surgery facility and have a CT Aortogram. For doctors working in a district hospital. You should refer this case to a tertiary center. In a meantime, few simple measure should be taken which is 1) Aim systolic BP 90-100, 2) Adequate pain management, 3) Aim for a good urine output > 0.5 cc/kg/hr, 4) palpate for other pulses to ensure no co existing vascular problem, 5) Ensure two large bore IV branulla available, 6) At least 3 pints whole blood already being crossed matched.