Aortic dissection

Case contributed by David Carroll , 20 Dec 2020

Diagnosis certain

Changed by David Carroll, 21 Dec 2020

Hidden edits. Some edits not affecting the appearance of this case have been suppressed.

Updates to Case Attributes

Presentation was changed:

50 year old female presenting with moderate intensity, non-radiating left upper thoracic back pain with exquisite paravertebral tenderness to palpation on exam. ~~Slightly hypertensive without other vital sign abnormalities~~S/O "sweats" at onset. BP 185/82, VS otherwise wnl. Extremities warm, skin moist. Carotid and radial pulses 2+ and equal.

Updates to Freetext Attributes

Description was added:

Vitals unchanged at 1 hour reassessment, partial symptomatic improvement after administration of topical lidocaine (patch to affected area), oral diazepam, and acetaminophen. Appears in mild painful distress while quietly seated. Repeat physical exam unchanged from prior. Perform a focused bedside ultrasound of the heart, abdomen, and retroperitoneum.

Updates to Freetext Attributes

Description was added:

After diagnostic confirmation additional large bore vascular access was started, STAT surgical consult requested, and an esmolol bolus/infusion administered, titrating frequently to target a HR<60 and an SBP 100-120. Analgesia achieved with fentanyl pushes. A right radial arterial line was placed. Nicardipine drip started after failing to reach target with esmolol. Hemodynamic targets achieved shortly after nitroprusside infusion started. Transferred to surgical ICU for medical management.

Aortic dissection

Updates to Case Attributes

Updates to Freetext Attributes

Updates to Freetext Attributes

How to use cases

Articles

By Section:

By System:

Cases

Radiopaedia.org