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Thu, 17 Oct 2002 08:11:57 -0400

Mr Bowman
That area of the thoracic aorta is sometimes difficult to image. the first image looks like valves. The other images is a bit confusing and I am not sure what to make of it.

Please understand that a negative exploration does not rule out an intimal flap. 

I would have done an arteriogram on this case since the images are not definitive.

Please also understand that MDCT, since it is isotropic, ie, cubic in data set, can be reconstructed in what ever views you liek and I would surely have done coronal, sagital MIP and surface rendered views before making a diagnosis. This is a revolution in mind set and we are just beginning to crawl: a necessary step before we walk

sal sclafani (from china)

In a message dated 10/11/2002 5:52:28 PM Eastern Standard Time, sumieb@compuserve.com writes:

> 
> 
> Trauma List
> 
> As promised, more of the story.
> 
> 42 year old male, motorcycle driver, hit a truck broadside at an
> intersection.  Head injury and multiple, open extremity fractures.
> 
> Multiple area CT's including of chest.  2 views of chest CT are attached
> which are the areas of interest.  Read by at least 2 radiologists and the CV
> surgeon. Scanner is a new GE "light speed"
> 
> Official reading is as follows: "there is an identified irregularity of the
> ascending aorta with the suggestion of a short segment dissection"
> 
> The study was repeated through this area and was again visualized as a
> possible intimal flap dissection
> 
> No angiography, no TEE.
> 
> Pt was transferred from my ED to another hospital across town where pump
> capability is located.
> 
> Median sternotomy was done.  Aorta explored.  No abnormality found.
> 
> Chest closed and attention turned to extremity injuries.  Pt did well.
> 
> I hope the CT quality is OK.  I got copies and then had to scan them in.
> 
> I had made the suggestion of doing an angio but was poo-pooed by all
> involved.
> 
> Was told proximal aorta injuries are not seen well on angio.  Oh well.  It
> appears they are seen too well with CT, so well they do not even have to be
> there!
> 
> Andrew J. Bowman, RN, CEN, CCRN, NREMT-P
> Patient Care Coordinator
> Education Coordinator (Trauma & Emergency Cardiovascular Care)
> Emergency Department
> Home Hospital Campus
> Greater Lafayette Health Services, Inc.
> Home Hospital Campus
> Lafayette, Indiana  47904
> USA
> 
> 
> > Mr bowman
> > any possibility of posting a jpeg of the "intimal flap" so we can see what
> was there.
> >
> > Was an aortotomy done? If not, how can we be sure that there was not an
> intimal flap.
> >
> > Please don't attack me. I likely would not want to have an isolated
> intimal flap explored anyway but it would be nice to know 
> whether the
> detractors are valid in their detraction of the images.
> >
> > Sal Sclafani

sal

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