Diagnose This #18

Hey guys, and welcome back to another installment of Diagnose This; the game that teaches as well as providing you with a much needed break from the textbooks.

Last week we were introduced to the gentleman with the tearing chest pain; a lot of people have been messaging us and yes, this is an aortic dissection. The intra-scapular pain is characteristic of a descending aortic dissection and, with the CT shown, it can be concluded that this is a Stanford B aortic dissection. This is most certainly an urgent problem; one of the major complications of aortic dissection is aneurysmal degeneration and rupture, so definitely want to be able to pick this one up and treat it quickly. Treatment for this individual depends on the extent of damage: if there was persistent pain and some limb/visceral ischaemia then surgery is the best option (either involving a laparotomy or endovascular stent grafting, although the latter is being shown to be much more effective in patients with Stanford B ADs with complications.) His chance of survival is not terrible, but not great; immediately he should recover quite well (given the usual complications of surgery), but as the aorta is already damaged this puts him at a much higher risk of further aortic dissections, aneurysms, and potentially ruptures. Close monitoring will be needed to ensure that this man has a long and happy life.

Now to the next case!

A 28 week pregnant 37 year old presents to the antenatal after her blood pressure was shown to be 165/100. She was normotensive previously, and is also complaining of a headache. She is G1P0 and is not sure if this has ever happened to anyone else in her family.

Her FBE is normal, but a urine dipstick shows 2+ for proteinuria. The patient reports reduced foetal movement.

What is your diagnosis? What treatment option would you consider for the lady? If left untreated, what are the signs, symptoms, and treatment options for her?

Find out next week on Diagnose This!



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