60yo M with acute onset severe R leg pain. When EMS arrived, | Figure 1
neurogirl13
Neurology
Case Summary
60yo M with acute onset severe R leg pain. When EMS arrived, he’d had also developed mild-moderate aphasia. Initial CT head negative for stroke but look what was lurking in the aortic arch! Huge dissection from the coronary arteries all the way to the iliac arteries, including a false lumen that had formed in the R leg causing limb ischemia. Suspect the aphasia was caused by a small stroke due to embolus thrown from the dissection. No tpa, of course! He was rushed to another hospital for surgical repair, so I never got to follow him up, but I’m hoping he did okay since he was in fairly good health and had no active bleeding from the dissection.
Images
- initial CTA
- dissection into L common carotid
- dissection into renal arteries (bonus hydronephrosis - massive kidney stone present but not pictured)
- false lumen starting at the origin of the R iliac artery
- reconstruction of lower arterial system
Related Cases
Answers:
- Wide-open aortic regurgitation
- Anti-hypertensive medication
The patient was administered Esmolol and Nicardipine. IR consulted and recommended dissection flap fenestration and true lumen aortic and branch-vessel stenting. Bilateral femoral access was obtained. Intravascular ultrasound (IVUS) revealed thrombus in the bilateral common femoral, external iliac, and common iliac arteries. Mechanical thrombectomy performed.