Dr. Pepe’s dedicated picture

Dear Friends,

It has been one week since we published the webinar and we would like to send you the pictures we promised. However, we made a big mistake: we didn’t provide for your adding your name and e-mail address to the answers, so I can’t know who’s right and who isn’t.

Since this is our fault, I will honor my word: once you have seen the webinar, you decide if you got three or more correct answers. If so, write a comment on this entry with your name and e-mail address and a dedicated picture of Dr. Pepe will be mailed to you.

Sorry about the inconvenience. I trust your honesty. Scout’s honor.

Dr. Pepe’s Diploma Casebook: CASE 130 – SOLVED

Dear Friends,

presenting today chest radiographs of a 70-year-old man with ischemic heart disease and dyspnea.

1. Fibrous pleural tumor of major fissure
2. Carcinoma of the lung
3. Loculated fluid in major fissure
4. Any 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 130 – SOLVED”

EMERGENCY – Long case 1

45-year-old male with acute chest pain radiating to the back and hypertension

Type A or type B dissection?

Click here for the answer

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.

Aortic Dissection Stanford type B

What are possible complications of an aortic dissection?

Click here for the answer

* 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?

Click here for the answer

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.

Dr. Pepe is preparing a new webinar!

Dear Friends,

I’m preparing a cycle of six webinars about basic interpretation of chest radiographs. The first one will be about the PA view, and today I’m presenting six cases that will be shown during this webinar.

You can respond in the blog, as usual. Answers will be given on Monday, November fifth, when the webinar will be posted on the Diploma web.

To encourage your participation, any of you who get three or more right answers will receive a dedicated picture of Dr. Pepe in their mail. Leave your answers in the comments if you want to receive the picture!

Good luck!

Continue reading “Dr. Pepe is preparing a new webinar!”