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Menaka Nadar, MD
University of Virginia
CC: abdominal pain, nausea
• HPI: 80 year old female with multiple medical comorbidites with right upper quadrant abdominal pain and sudden, overwhelming feeling of nausea. Managed symptoms at home for one week. Finally presented to primary care physician and was sent to the ER.
PMH• Atrial fibrillation• Severe pulmonary
hypertension with moderate RV dysfunction
• Hypertension• Hyperlipidemia• Diabetes Mellitus Type 2• Obesity
PSH• No prior cardiovascular
surgery
Medications• Coumadin for atrial
fibrillation– INR 1.7 on admission
• Amiodarone• Cardizem• Coreg• Lasix• Losartan• Onglyza• Levemir
Allergies• None
Imaging
Diagnosis/Discussion
• 80 year old female with symptomatic contained rupture of distal descending thoracic aortic penetrating ulcer– Ulcer 2cm above the celiac artery
Potential Complications
• Endoleak• Stent migration• Stent fracture• Infection• Bleeding• Stroke• Myocardial infarction• Acute kidney injury
Intervention
PseudoaneurysmStatus post stenting
Summary
• 80 year old female with symptomatic contained rupture of descending thoracic penetrating aortic ulcer successfully treated with endovascular stent graft.