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Presentation transcript:

University of Virginia Menaka Nadar, MD University of Virginia MRN

CC: abdominal pain, nausea HPI: 80 year old female with multiple medical comorbidites with right upper quadrant abdominal pain and sudden, overwhelming feeling of nausea. Managed symptoms at home for one week. Finally presented to primary care physician and was sent to the ER.

Severe pulmonary hypertension with moderate RV dysfunction PMH Atrial fibrillation Severe pulmonary hypertension with moderate RV dysfunction Hypertension Hyperlipidemia Diabetes Mellitus Type 2 Obesity PSH No prior cardiovascular surgery Medications Coumadin for atrial fibrillation INR 1.7 on admission Amiodarone Cardizem Coreg Lasix Losartan Onglyza Levemir Allergies None

Imaging

Diagnosis/Discussion 80 year old female with symptomatic contained rupture of distal descending thoracic aortic penetrating ulcer Ulcer 2cm above the celiac artery

Potential Complications Endoleak Stent migration Stent fracture Infection Bleeding Stroke Myocardial infarction Acute kidney injury

Intervention Pseudoaneurysm Status post stenting

Summary 80 year old female with symptomatic contained rupture of descending thoracic penetrating aortic ulcer successfully treated with endovascular stent graft.