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Forum Name: Diseases of the Aorta

Question: symptoms aortic dissection


 kathys555 - Sat Nov 15, 2008 5:15 pm

car accident 2006
approx. wt 130lbs. bulging disc c 4-7 w/ neural foramina narrowing more on left, herniated disc L5/s1 w/radiculopathy more on left, t -3 psterterior disc displacement w/desication, t-12 hemangioma,severe headaches, had a concussion 2006. always had low blood pressure.

leading up to now; weight 136lbs.

tested positive for lupus anticoagulant 2xtimes w/in last 4 months, high RDW, high ldl only on last test, right hand clutching for a while now, spacey feeling less since accident (something like that) severe chest pain for last few months (ripping feeling) had barrium swallow (normal) finally went to hospital checked, elevated enzymes but heart heart is fine. In hospitol blood pressure was lower than I have ever seen it like 86/48 w/ 97 beats, several other times systolic stayed in 80's but distolic got as low as 42 beats in 90's

the chest pain is in front about at the 2nd 3rd rib, my sternum is elevated in that spot. I showed them at the hospital, I also have a ct scan that was done a few weeks ago looking for neck mass when the did ct scan they did brain down to aorta ( at least that's what I think it is. My family doctor told me it's my heart.( I DISAGREE)The last episode was yesterday this time had been very dizzy.


in this link figure 9 and 10 are what I see on my ct scan except mine is huge pushed out and to the left and pushing on sternum, the sternum in the ct is crooked so is mine more on left

http://www.med.wayne.edu/diagradiology/ ... tinum.html

http://tinyurl.com/yov389


anyway I showed the admitting er doctor she didn't say anything, I thought well maybe they'll look it over but they didn't. So here I am at home waiting to go to a heart hospital wednesday to get answers so in researching more things I thought maybe if I sign up to your site you could let me know what you think. Greatly appreciated.

from kathy, I am someone's daughter,mother,grandmother,aunt, neice, cousin, sister and freind. Thank you Doctor

ps other important link

http://heart-disease.health-cares.net/a ... mptoms.php
 kathys555 - Sun Nov 16, 2008 3:06 pm

also I have jaw and neck pain, redness on my cheeks and nose. I do have neck pain anyway w/bulging discs but it seems alot worse than it was. I have back pain, leg pain, severe headaches, muscle cramps, muscle spasms ect...

no fever, no lymes, no sickness, no anything.
 kathys555 - Tue Nov 18, 2008 9:41 am

blood work from last week

mch,mchc,lymph%,creatinine low
neut%, troponin high
total and ldl cholesterol high hdl normal
lupus anticoagulant
 John Kenyon, CNA - Wed Nov 19, 2008 10:19 pm

User avatar Hi there -

Unable to see the actual CT films of your thorax I can only go on the history and symptoms you provide. While it is not impossible you have an aortic dissection, it sounds very unlikely. It is relatively easy to recognize on x-ray, let alone on CT, but mainly it is rarely a chronic condition, is usually progressive, acute, emergent, presenting with deteriorating vital signs.

Again, it is not outside the realm of possibility, and someone should at least discuss this with you. Hopefully by now (Wednesday) they have. If there is an aneurysm (perhaps not dissecting, possibly due to trauma from 2 years previous) it should be manageable. It would appear to be not emergent, but could be acute.

Other possibilities are a congenital rotation of the heart outside the normal limits (not due to trauma -- some people have this, function with it, are asymptomatic), or a pseudoaneurysm resulting from trauma, which could cause the sort of large mass you describe in your CT films. This is usually quite manageable as well, and can also cause pain similar to that of a dissection, but without the catastrophic outcome you would likely have experienced already had that been the case.

One other possibility is that what you're seeing is pericardial effusion, which may or may not be related to the trauma of 2 years previous. This can cause the same sort of pain symptoms. The blood pressures you quote, while notable, are not especially a cause for alarm, although they do seem to correlate with your sensations of lightheadedness.

All in all the collection of findings warrant at least a closer look at the films (hopefully that's been done by now) and at the very least discussed with you). I suspect you have some sort of anatomical derangement, probably a result of the decellearation involved in the auto accident of 2 years ago, but probably not an aortic dissection, which sometimes does follow this sort of mechanism of trauma, but very rarely remains chronic. Pseudoanerysm is another possibility, as is pericardial effusion. There are others, also, which are less menacing in the short run, but anything crowding the area you describe should probably be reduced at the very least.

I wish I could see your films, and hope you will follow up with us here post visit to heart clinic to let us know what you learn. Meanwhile, the best of luck to you.
 kathys555 - Thu Nov 20, 2008 8:18 pm

Thank you for your response.

Tuesday (I think it was) went back to see radiologist she said that's your pulmonary arch. I said I thought it's my aortic arch, and the asked whi is it so large and pressing on sternum she said it's supposed to look like that, it's normal. I showed her where my chest sticks out and she said pulmonary arch. So research online told me different. Wednesday seen cardiologist and they did their evaluation told me to wait for my questions until he was done. Hearts fine. Well first question was what is this ct of he said AORTIC ARCH. Then I got a little excited and asked why is it so large and the whole sternum thing he asked what did the report say, I said the report was originally done for neck mass, didn't say anything about aorta. Well he kept saying I do heart go back to radiologist get them to do another report. I was so excited he went a got another doctor to just come in and say we do heart, we do heart. I was dressed by the time they came back in because I knew I would not get a straight answer.

Today went back to family doctor and told her she said that's my heart, radiologist said pulmonary arch and cardio said aortic arch. Well she didn't like the fact I reminded her what she said and she was wrong, she tried to say she said heart structures, leading to the heart and finally saying she said aorta and then said it looks normal to her...WHAT how can it look normal to her if she doesn't even know what she's looking at? Oh and a few other remarks I didn't appreciate, I am in search of a new family doctor...lol

I'm sorry I'm ranting. I get a little excited sometimes when it comes to things that need attention.

last friday had a few minutes only of extreme pain followed by dizziness this time. Few days ago I had an episode of felling like I was fading away.

I will get a camera take pictures of what I'm talking about and I will bring them here, I'm not sure how to bring them here. Do you have a link or email address I could get the to?

I really appreciate you being here for us. If after you see the pictures and want to call me crazy I will accept that with a crazy laugh and say thank you...lol
 John Kenyon, CNA - Thu Nov 20, 2008 9:51 pm

User avatar Hi there -

It's got to be extremely frustrating getting all this runaround about something that should be obvious. Of course a radiologist would best be able to recognize what's being looked at, but just based on the way the view was shot, I'd guess the reason for all the confusion is that one looks down at the aortic arch with the apex of the heart normally protruding beyond it against the left part of the ribcage.

I have no earthly clue, as yet, how one posts pictures on this site (I haven't had any reason to learn. I'm remiss, I know), but if you can figure out how it's done or find someone who does know, I'd love to see the shot. I may be able to figure out what's causing all the confusion, or if it's normal or not. There is, of course, a great deal of anatomic variation, so we'll see what we see.

I don't blame you for ranting, and you certainly have good reason for it. If a medical person doesn't know the answer, the best answer becomes "I don't know", not "It's this -- or, no, I guess it's that." If I'm guessing I'll say so. Hopefully I'll be able to tell if I can see it. I'm no radiologist, but I've looked at a few of these things.

New family doctor might be a good idea at this point. :)

I'll be waiting to hear/see more from you. Good luck with that.
 kathys555 - Thu Nov 20, 2008 10:01 pm

thank you so much I'll try to get them for you tomorrow or the next day I have to get the camera, then figure out how to get it to you. I'll teach you so next time you'll know for someone else. I'll talk to you soon.
 kathys555 - Thu Nov 20, 2008 10:07 pm

ps.

you said "I'd guess the reason for all the confusion is that one looks down at the aortic arch with the apex of the heart normally protruding beyond it against the left part of the ribcage"

in that series the aortic arch is the last shot, remember they were looking at a neck mass. They said that looked like fatty tissue (or something along those lines)
 John Kenyon, CNA - Fri Nov 21, 2008 12:29 pm

User avatar That would be great. Knowing would be a huge help, too. I'm a little bit technologically compromised sometimes. :)
 John Kenyon, CNA - Fri Nov 21, 2008 1:46 pm

User avatar Regarding your PS: Duly noted.
 kathys555 - Fri Nov 21, 2008 9:06 pm

http://img505.imageshack.us/img505/2923/1011002ek7.jpg

http://img505.imageshack.us/img505/3306/1011005mp9.jpg

http://img505.imageshack.us/img505/9162/1011007mm0.jpg


okay they are here and they are backwards, in other words look at bottom one first and work your way up. I didn't do these completely myself so I can't explain sorry. Now you'll notice the brick in the spine that is actually not in me lol... I did take the pics and didn't realize I got the house in there I thought it was sky.

but I think you can make out what I'm talking about. I forgot the films @ my brothers so if you need table location whatever let me know I'll pick them up tomarrow, but I do know the are 2.5mm thickness.

Thank you talk to you soon
 John Kenyon, CNA - Sat Nov 22, 2008 12:50 pm

User avatar Hi again, and thanks for the pictures. Don't worry about how to load them. I'll figure it out eventually -- I hope. :)

OK then, as we progress up toward the final (and most telling) view, it looks very much like a dilated aortic arch to me. There is definitely no cardiac profile shown in the view. An MRI would have been more detailed, but CT is the next best thing, and that's almost certainly not the pulmonary arch, which shouldn't be remarkable. This appears (to my non-radiologist's eye) to be a dilated aortic arch, quite possibly a false aneurysm (something I've only seen once or twice in my career personally, and both times the result of automotive trauma). While what we're seeing in that last (top) shot could be a normal variant at the extreme large end of the spectrum, given the symptoms that go with it and the history of deceleration trauma, it makes a good argument for urgent study to rule out, beyond any reasonable doubt, dilated aortic arch with possible false aneurysm/false lumen. The word "false" can be misleading, as it is still carrying blood (outside the normal aorta) and can produce what appears to be a large dilation. Some normal aortic arches can appear quite large from the superior view, but there are features of this view that suggest some derangement, if I am seeing what I believe I'm seeing. The arch appears to be dilated from the aortic root onward til it disappears from the view, which would include the entire arch, and which is why it looks to me like a false aneurism.

Based on the history, the appearance of the structures in the chest, the very firm, almost compressed relationship to the sternum, and the symptoms you describe, this should probably be evaluated by a vascular surgeon urgently. I think the quality of the images, because they are CT rather than MRI, may be causing some confusion and disagreement, and I may be adding to it, but if there is any doubt (and in my mind there is considerable doubt) then it should be clarified at once, for reasons I don't need to explain to you here.

In short, I think it is likely you've read this right, or at least pretty close to right. I'd be perfectly happy to be wrong, but there's only one way to be certain. MRI of the chest laterally and superiorly, aimed at the normal location of the aortic arch, as well as an echocardiogram to look for signs of aortic incompetence or changes to the root and valve. There's nothing to lose by doing this, and possibly everything to gain.

Thanks again for the pictures, which really do support your concern, in my humble opinion. As I said, I've seen a couple of these over the years, and they turned out to be traumatic false aneurysms. You certainly do fit the profile. "If it walks like a duck...", etc.

Please let us know what you do next and what you find out. I feel this should be studied urgently until such time as someone can absolutely disqualify the appearance of a dilated aortic arch.

Best of luck to you. Thanks again for going to all the trouble with the pictures. That's a nice light fixture you've got there, too. :)
 John Kenyon, CNA - Sat Nov 22, 2008 12:56 pm

User avatar PS - The elevated troponin level, although there are no actual figures posted, also add some weight to the possibility that this is not a normal arch. Dilation, dissection, etc., which begins at the root, as this one appears to, can cause some clinical signs and symptoms of MI, of which elevated trop. is one. Just another observation. Stay in touch, please.
 kathys555 - Sat Nov 22, 2008 2:32 pm

WOW!!! How I wish we were wrong and could give you that crazy laugh...lol

Tropinin yes I didn't realize I forgot to put that up there. They have it as 0.04 then 0.10 then 0.07 3 different times

oh when they kept me in hospital last week or so overnight they were injecting me (twice) w/blood thinner that's probably why my blood pressure was lower than I ever seen.


Well, I appreciate you AND everyone else being here I'm trying to stay calm. I'm going to jump in shower and go to a hospital outside of this town maybe someone there will know what they're looking at lol...

Thanks and I pray I will talk to you soon Take care, Kathy

ps I'll check back in one more time before I leave if you would like to say something.

here's my # if you don't here from me one of my wonderful sons will answer. please make sure you don't put on the board ty 609-261-1292
 kathys555 - Sun Nov 23, 2008 1:10 pm

remember that laugh? well here you go...lol

http://www.youtube.com/watch?v=WpripwOz ... re=related

They said there isn't anything wrong they checked from aorta to kidneys w/contrast ct and said my blood work is fine. I said all I wanted was a straight answer and I couldn't get it that's why I am here. So next step is Rheumatologist to find out why chest bones sticking out, why tested positive for lupus anticoagulant and maybe they can get to the root of the severe chest pains We'll see.

I will try to post the latest ct so you can have them online in case someone else experiences what I have and maybe this thread can help answer their questions.

Thank you all for being here...

http://www.123greetings.com/thank_you/e ... day40.html
 John Kenyon, CNA - Thu Dec 04, 2008 12:39 pm

User avatar Hi again -

Sorry it took so long to reply, but apparently the posts were held up or I would have been notified of them. Anway, first, the TnT (troponin) levels are, as near as I can tell, based on my lab training, withing normal limits regardless of which measurement method is used, so I'm perplexed by that, but in a good way at least.

Evidently you have a normally odd aortic arch profile, which of course is the kind of thing that happens all the time, and which is why there are radiologists to read those films. Very good news, anyway. Now to find out just what is going on.

The laugh is priceless and timely as well. If only that could be bottled!

You're very welcome, and the team here thanks you for using The Doctors Lounge to try and find your answer. Hope you will stay in touch and keep us updated.

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