1. University of Virginia
Menaka Nadar, MD
University of Virginia
MRN

2. 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.

3. 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

4. Imaging

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

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

8. Intervention
Pseudoaneurysm
Status post stenting

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