unusual case

Thu May 1 19:47:42 BST 2008

We recently had a small plane pilot crash victim allergic to iodine and so assessed the aorta with TEE.
Typical ascending aorta dissections are relatively easy to diagnose with a visible flap and a second lumen with flow.
Commonly there is also AI and pericardial effusion accompanying. Arch is not visible on TEE due to the left mainstem bronchus interposition. Descending aorta is nicely visible on long and short axis ("tube" and "salami" cuts), typical site transsections are accessible. One can also see AIH - aortic intramural hematomas - no flow in the accessory lumen.
There are VOMITs possible - the arch cen have a reverberation artifact which looks like a second lumen. Also, which happened in our case, there is the left innominate vein which normally adheres to the arch and has flow in the opposite direction, which can be pulsatile so close to the right heart, especially with e.g. TR. It too can mimic a dissection.
 Ivan Hronek MD
Los Angeles, CA
http://health.groups.yahoo.com/group/Anesthideas/

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----- Original Message ----
From: jduchesne1 <jduchesn at tulane.edu>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Thursday, May 1, 2008 10:38:35 AM
Subject: Re: unusual case

It is really hard to see the ct Ao injury which I think that is what you r trying to point out. In the event of a true (not a VOMIT) Ao injury with combine TBI, non operative management with control of patient delta P/delta T with breviblock is indicated. On the other hand special attention needs to be taken for good ICP/CPP readings in order to prevent secondary brain injury. Good judgment and close ICU care is a most.
Please send more cuts of the CT.
Always remember communication is of the essence among physicians in polytrauma patients.
Good case.
Juan
CharityOne
Sent via BlackBerry by AT&T

-----Original Message-----
From: Tchaka Shepherd <tshepherdmd at hotmail.com>

Date: Thu, 1 May 2008 10:09:29 
To:"Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Subject: RE: unusual case

Can you send more images of the CTA?

----------------------------------------
> To: trauma-list at trauma.org
> From: nappio at aol.com
> Date: Thu, 1 May 2008 16:50:34 +0000
> Subject: Re: unusual case
> 
> CHI and c spine injury. What is unusual?
> Sent from my Verizon Wireless BlackBerry
> 
> -----Original Message-----
> From: "Michael Stein M.D." 
> 
> Date: Thu, 1 May 2008 19:37:42 
> To:"'Trauma & Critical Care mailing list'" 
> Subject: RE: unusual case
> 
> 
> Not enough cuts from the CTA but...
> If Neuro don't want him STAT in the OR, perform FORMAL Arch + 4 vessel
> Angiography and go on from there.
> Mickey
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of daniel simon
> Sent: Thursday, May 01, 2008 6:29 PM
> To: trauma-list at trauma.org
> Subject: unusual case
> 
> 43 year old motorcycle crash victim , on scene intubation for GCS of 5. On
> admission intubated and ventilated, B.P 130/80 P 82 sat 100% , GCS 7 (T) .
> PE: skin lacerations and  central hematoma anterior neck - zone 1.
> Head CT - SAH, Frontal contusions,small Frontal SDH, many skull fractures.
> C-spine:  fracture of C1
> Chest XR and relevant cuts from the chest  CTA included.
> Abdominal CT normal
> What would you do now?
> 
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