A 48-year-old male patient:
* HIV (+)
* Presented to emergency with headache, confusion, N/V



What do you see?
Dear Friends,
Today I am showing chest radiographs of a 39-year-old man with high fever and malaise.
What do you see?
Come back on Friday to see the solution!
Continue reading “Dr. Pepe’s Diploma Casebook: CASE 135 – SOLVED!”
Dear Friends,
Today I am showing chest radiographs of a 81-years-old man with chest pain five years after left pneumonectomy for lung carcinoma
Diagnosis:
1. Broncho-pleural fistula
2. Intestinal hernia
3. Empyema
4. None of the above
What do you see?
Check the images below, leave your thoughts in the comments section, and come back on Friday for the answer.
Continue reading “Dr. Pepe’s Diploma Casebook: CASE 131 – SOLVED”
45-year-old male with acute chest pain radiating to the back and hypertension
Type A or type B dissection?
Type B, entry zone/intimal tear after left subclavian artery.
False lumen often of lower contrast density due to delayed opacification, as in this case. Origin of coeliac trunk, SMA and right renal artery usually from true lumen and origin of left renal artery usually from false lumen.
Teaching point: Notice that dissection continues in the SMA with intramural thrombus. Usually no fear of bowel ischemia due to arc of Riolan with IMA
Notice in this case: Right renal artery comes off from false lumen and dissection continues in it. Right kidney parenchyma enhances less than left, due to hypoperfusion, high risk of ischemia.
What are possible complications of an aortic dissection?
* Dissection and occlusion of branch vessels
* Abdominal organ ischaemia
* Distal thromboembolism
* Aneurysmal dilatation: this is an indication for endovascular or surgical intervention
* Aortic rupture
What is the appropriate management?
Aggressive blood pressure control with beta blockers as they reduce both blood pressure and also heart rate hence reduce extra pressure on the aortic wall.
In this case: Complicated type B dissection and persistent hypertension led to Bentall thoracic surgery with stent, due to risk of proximal continuation in ascending aorta, coronaries and neck vessels.
Prof. Caceres invites you to watch his latest webinar that answers the questions from last post.
We hope you enjoy it!