1 / 23

HISTORY

HISTORY. A 36 year old female admitted with H/o pain in the Rt upper limb & Giddiness while working with the Rt upper limb for the past 6 months. She has right eye pain also while working with the upper limbs. No H/o fever, chest pain, dysponea, cough Bowel & Bladder habits normal.

benard
Télécharger la présentation

HISTORY

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. HISTORY • A 36 year old female admitted with H/o pain in the Rt upper limb & Giddiness while working with the Rt upper limb for the past 6 months. She has right eye pain also while working with the upper limbs. • No H/o fever, chest pain, dysponea, cough • Bowel & Bladder habits normal

  2. PAST HISTORY: No H/o DM / HT / PT / BA / IHD / Epilepsy • PERSONAL & FAMILY HISTORY: Nil significant • GENERAL EXAMINATION: Conscious, oriented, afebrile Pallor + No clubbing / cyanosis / PE / Jaun / GLA /elev.JVP

  3. VITAL SIGNS - PULSE

  4. Blood Pressure: • RESPIRATORY RATE & TEMP: Normal

  5. SYSTEMIC EXAMINATION: CVS : S1, S2 +, Hyperdynamic impulse EDM + in AA RS : NVBS +, No added sounds ABD : Soft , No mass palpable CNS : NFND

  6. NECK: A 3 * 3 cm sized swelling palpable in the Lt carotid triangle, expansile impulse on palpation +, soft , smooth surface. ? ANEURYSM OF CAROTID ARTERY • PROVISIONAL DIAGNOSIS AORTOARTERITIS / ?Carotid Aneurysm

  7. INVESTIGATIONS • Hb % : 10.4 gms • TC : 9500 • DC : P72 L26 E2 • ESR : 10/25 • PCV : 26 • Urine R/E: Normal • RBS : 119 mgs • Bl.Urea: 16 mg • S.Crea : 0.6 mg

  8. S.Electrolytes: Na+ : 126 meq/L K+ : 2.8 meq/L • LFT: STB: 0.9 mg SGOT: 19 IU/L SGPT : 18 IU/L SAP : 65 IU/L T.Protein : 7.5 gms Albumin : 4.8 gms • ECG : LVH • CXR : Aortic knuckle prominent &calcified Cardiomegaly +

  9. ASO : Neg • CRP : Neg • RF : Neg • ANA : Neg • Mantoux test : Neg • HIV : Neg • VDRL : Neg • Anti- HCV : Neg • HBsAg :Neg

  10. USG ABD: Prominent supra renal aorta ?Aneurysm , SMA prominent. • Echo : AR (mod) No AS TR (mod) MV (normal) • Total Cholesterol: 161 mgs • Thyroid Function Tests: Normal • Fundus : Normal

  11. SURGICAL, RHEUMATOLOGICAL, CARDIAC OPINION: ? AortoArteritis • VASCULAR SURGEON OPINION: ?Aorto Arteritis / ? Carotid Aneurysm , Suggested Doppler study • Doppler Study of Vascular System: 1.Plaque in Rt CCA causing 59 % stenosis of CCA.Due to the stenosis there is no detectable diastolic flow in Rt ICA & Rt ECA

  12. 2. Diseased LCCA indicated by hyperechoiec and irregular intima , no detectable diastolic flow in Lt CCA indicating occlusion prior to LCCA origin. ? In Arch of Aorta 3. Due to the plaque highly pulsatile flow with nil diastolic flow noted in the Lt carotid bulb, Lt ICA & Lt ECA 4.Lt vertebral artery shows no diastolic flow but normal systolic velocity -? Arterial narrowing in ipsilateral SCA

  13. 5.Normal study of Renal arteries, infrarenal aorta , both lower limb arterial system. In these normal flow & velocity noted.

  14. In our case……. • There is claudication of upper extremities • Aneurysm of carotid artery • Aortic Regurgitation • Feeble upper extremities pulses • Typical Doppler study of arterial system …..

  15. FINAL DIAGNOSIS AORTOARTERITIS/ AORTIC REGURGITATION

  16. AORTOARTERITIS • AA is a pan-arteritis involving all the three layers causing extensive intimal proliferation, inflammation of media & adventitia followed by marked fibrous scarring. • Involves aorta & its major branches, pulmonary artery & its branches • TYPES: TYPE I : Inflammatory process is localised to arch of aorta & its branches

  17. TYPE II: Lesions involve the thoraco-abdominal aorta & its branches without the involvement of arch • TYPE III: Combined Type I & Type II • TYPE IV: Pulmonary involvement in addition to features of Type I ,II or III • TYPE V: Involvement of coronary arteries

  18. COMMON PRESENTATIONS: 1.Unequal pulse 2.Hypertension (due to renal artery stenosis) 3.Renal failure 4.Heart failure(HT /Valvular lesions) 5.AR ( Root dilation / valvular) 6..Intermittent claudication 7.Aneurysmal AA( high incidence of AR,HT, Elevated ESR) 7.Others( CNS,Skin,eye changes)

  19. Clinical Diagnosis of Aorto- Arteritis: I. One Obligatory criteria: < 40 yrs II. Two major criteria : Lt & Rt mid subclavian artery lesions III. Nine minor criteria : 1.High ESR 2.CCA tenderness 3. hypertension 4.Aortic Regurgitation 5.lesions of (pulmonary artery,Lt mid CCA , distal BCT, thoracic aorta & abdominal aorta • High Probability of AA: OC + Two/one Major + >=2 / >=4 minor criteria

  20. American College of Rheumatological criteria: 1. Age of onset of disease < 40 yrs 2.claudication of extremities 3. decreased brachial artery pulse 4. BP difference > 10 mmHg bt arms 5.bruit over subclavian artery or aorta 6.arteriogram abnormality 3 of these 6 criteria suggests diagnosis of Aorto-Arteritis

  21. TREATMENT • Glucocorticoids • Cytotoxic drugs (cyclophosphamide, azathioprine, methotrexate) • Antihypertensives &decongestive therapy • Percutaneous Transluminal angioplasty • Surgery

More Related