virgola82
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A 59 yo man who works in a birdseed packaging plant was tightening a 5 lb cap onto a container when he had the sudden onset of a chest pain. The pain moved into his middle back and upper stomach. Hehas a history of hypertension but otherwise had been healthy. Initial physical exam was unremarkable except for a blood pressure of 175/95 mmHg (no significant difference between the arms). Emergency ct of the chest showed a type B aortic dissection with a maximal aortic diameter of 4.6 cm. He was managed medically with metoprolol, amlodipine and furosemide, and remained pain free for the next 7 days after which he was dismissed. He now presents 8 wks later for follow up. He currently feels well. PE is normal. Electrolyte panel and cbc are normal. What is the most appropriate next step in the evaluation of this patient?
A. Posteroanterior and lateral chest x-ray
B. CT of chest and abdomen ( with and without contrast)
C. Transthoracic echo
D. Aortography
E. Screening family members for aortic dilatation
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| suv
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C?
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| young_doc
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patient is stable... B?
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| elitoki
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patient should be followed with radiologic studies each 3-month intervals for the first year and every 6 months for the next 2 years.
Patient is stable .. I'd go with B.
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| Justice
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B. CT of chest and abdomen
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| dr in trouble
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B
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| virgola82
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The right answer is B. F/U in pt with type B aortic dissection include: history, PE, BP assessment, evaluation of any new symptoms related to the dissection (like claudicatio, abdominal symptoms or pain). Lab test should include BUN and creatinine, hematologic group testing and serum K. Imaging should include PA and lateral CXR + CT or MRI to assess aortic diameter persistence of false lumen or involvement of branch vessels. Transthoracic echo cannot reliably image the whole descending aorta.
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