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Vascular/Cardiac » Aortoiliac
Abdominal aortic dissection
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Presentation Patient is a 53 year old man who arrived in the Emergency Room complaining of epigastric pain. He stated the pain at times radiated to his back and he felt pressure in his chest. He had no other symptoms. The patient's medical history included hypertension and nephrolithiasis. He smoked a pack of cigarettes a day and was obese. He was evaluated for a myocardial infarction. An EKG showed a normal sinus rhythm. Chest X-ray and all lab values were within normal limits. He had no rebound tenderness or nausea. He was given oxygen and started on nitroglycerin and aspirin. The patient was admitted to the ICU for angina and observation. Subsequent abdominal Ultrasound and Chest CT scans were ordered. 
 
 
 
Caption: Sagittal Abdominal Aorta
Description: Note echogenic interface within aorta and parallel to the aortic walls.
 
 
 
Caption: Transverse Abdominal Aorta
Description: A thin echogenic layer is seen within the aorta, suggesting a membrane.
 
 
 
Caption: Color Doppler of Abdominal Aorta
Description: Color Doppler of the abdominal aorta demonstrates normal-appearing blood flow anterior to the echogenic membrane and minimal flow posterior to it.
 
 
 
Caption: Origin of Right Iliac Artery
Description: The echogenic membrane extends into the right iliac artery.
 
 
 
Caption: Sagittal Left Iliac Artery
Description: This sagittal view of the left iliac artery also shows the membrane extending from the abdominal aorta into the iliac artery.
 
Differential Diagnosis Thrombus within aorta
Retained catheter
 
Final Diagnosis Extensive aortic dissection along the entire course of the abdominal aorta and into the iliac arteries. The femoral arteries were not involved.
 
Technical Details Case provided courtesy of Siemens.
 
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