http://ether.stanford.edu/library/cardiac_anesthesia/TEE/Khan_typeA.pdf

Clinical, Diagnostic, and Management Perspectives of Aortic Dissection

Renal osteodystrophy

Acute aortic dissection is the most common fatal condition that involves the aorta; nevertheless, despite major advances in noninvasive diagnosis, the correct antemortem diagnosis is made in less than half the cases. To promote continued improvement in the prompt recognition of aortic dissection, we present a review of the Mayo Clinic experience with 235 patients who had 236 substantiated aortic dissections. At the time of initial assessment, 158 patients (67%) had acute and 78 patients (33%) had chronic aortic dissection. Hypertension was the most common predisposing factor (78% of patients overall). The acute onset of severe chest pain was the most common initial complaint (74%), but 33 patients (15%) had painless aortic dissection and abnormal chest roentgenographic findings. Less common manifestations included congestive heart failure, syncope, cerebrovascular accident, shock, paraplegia, and lower extremity ischemia. The initial clinical impression was aortic dissection in 62% of patients overall. In 17 patients (28%), the correct diagnosis was not made before postmortem examination. Although the clinical features of aortic dissection have gained wider appreciation, the diagnosis still remains unsuspected in a substantial number of patients. In a patient who has a catastrophic illness and unexplained symptoms that could be of vascular origin, especially in the presence of chest pain, aortic dissection should always be included in the differential diagnosis.

https://www.mayoclinicproceedings.org/article/S0025-6196(12)60599-0/pdf

Clinical Features and Differential Diagnosis of Aortic Dissection: Experience With 236 Cases (1980 Through 1990)

Vascular complications associated with spontaneous aortic dissection

The first edition (1981) of this comprehensive work weighed 25 lb and had 3300 pages. This entirely new third edition, published 14 years later, has grown to 45 lb and 4850 pages. This growth is not due to inflation but is the direct result of the information explosion. The multiplication of techniques for imaging and studying the bone and soft tissues has made choosing the best method for examination of the patient more difficult and, in an environment in which cost-effectiveness has become a byword, more important. An underlying principle of this work is to guide the physician in the choice of the technology to be employed to get essential information quickly and efficiently. Dr Resnick has called on a group of 40 contributors for special information, but he himself has played a major role in the writing and has been more than an editor, thereby ensuring a consistent and

Diagnosis of Bone and Joint Disorders

Fluoroscopically guided percutaneous biopsy of pulmonary masses is an accepted procedure, but large neoplasms often have necrotic areas which, if aspirated, do not afford a pathologic diagnosis. Such tumors may require multiple punctures or procedures to establish a diagnosis. A prebiopsy contrast-enhanced CT scan selectively demonstrates the extent of peripherally located, viable tumor tissue. Three cases of initially frustrated lung biopsies in which viable, diagnostic tissue was localized for fluoroscopic aspiration using the contrast-enhanced CT scan are presented.

https://www.ajronline.org/doi/pdfplus/10.2214/ajr.140.2.265

Avoidance of negative percutaneous lung biopsy using contrast-enhanced CT.

Diversion colitis demonstrated by double-contrast barium enema

The ischemic leg as the only clinical manifestation of an aortic dissection is rare. Without the usual symptoms of an aortic dissection, this diagnosis may easily by overlooked during routine peripheral angiography for the ischemic limb. Three cases are reviewed in which the patient was thought to have a spontaneous peripheral vascular occlusion, but was later found to have an aortic dissection without the usual thoracic or abdominal symptoms. The radiologist should observe carefully for signs of dissection such as fusiform narrowing of a vessel, nonfilling of branches of the aorta, or displacement of the intima into aortic lumen.

Aortic dissection manifested as leg ischemia

In the last few years, antegrade percutaneous placement of ureteral stents by the radiologist has been popularized [1 -3]. The most commonly used stent device is the double pigtail catheter, a design of simple elegance [4]. However, technical difficulties in traversing the soft tissues of the back and positioning of the pigtail in the renal pelvis occur commonly. Two refinements in technique that address these problems are described here. First, difficulty in negotiating noncompliant soft tissues and renal parenchyma is greatly decreased by use of a Desilets-Hoffman sheath (Cook). Second, excellent control of the final position of the pigtail in the renal pelvis may be achieved by use of a suture threaded through two side holes in the middle of the proximal pigtail curve.

A simplified method for placement of internal ureteral stents.

A case of middle lobe torsion occurring after a right upper lobectomy is described. The appearance of a wedge-shaped opacity with a characteristically positioned oblique fissure should alert the radiologist to the possibility of torsion. The combination of radiographic, bronchoscopic, and clinical findings should direct the clinician to the correct diagnosis.

M. L. Pinstein

Papers

Avoidance of negative percutaneous lung biopsy using contrast-enhanced CT.

Diversion colitis demonstrated by double-contrast barium enema

Aortic dissection manifested as leg ischemia

A simplified method for placement of internal ureteral stents.

Middle lobe torsion following right upper lobectomy.