Doctor Consultant Report
walk with stick ,ex-smoker ,non drinker, live with family
hoarseness for around 4 months
CXR: aortic aneurysm
ECG: fast AF
sCr 168 on admission
CT brain: chronic ischaemia
1. HT/CRF/ right renal artery stenosis with fast AF
2. hoarseness? related to aortic aneurysm
consulted ENT L VC palsy
urgent CT thorax with contrast done
1. 8.0cm aortic arch aneurysm distal to the origin of left subclavian artery. Mixed hyper- and hypo-dense intra-mural density, suspicious of subacute intra-mural hematoma. No CT evidence of dissection or rupture.
2. Atrophic right kidney with narrowed right renal artery, suspicious of right renal artery stenosis
Examinations: contrast CT Thorax
left mediastinal mass
Contrast CT Thorax
A few hypodense lesions are noted at the thyroid. The largest one measures 3.4cm at left lobe of thyroid
Aortic aneurysm at the arch aorta just distal to the origin of left subclavian artery is seen. It measures ~8.0cm in diameter. Mixed hyper – and hypodense intra-mural density is noted, which is most prominent at the left lateral aspect. In view of pre-contrast hyperdensity , subacute intra-mural hematoma has to be considered. DDx would be intra-mural thrombus.
No intimal flap is seen. No false lumen is appreciated. No active contrast extravasation.
The ascending aorta and descending aorta is not dilated. Abdominal aorta is unremarkable
Cardiomegaly. No pericardial effusion.
Lungs are clear. A0.7cm calcified granuloma is noted at left upper lobe
No pleural effusion.
Trachea and major bronchus are patent.
Liver, spleen, adrenals and pancreas are unremarkable.
Atrophic right kidney. Abrupt termination of contrast in the right renal artery near the origin from aorta is noted. Faint opacification of the proximal renal artery is demonstrated. Features is suspicious of renal artery stenosis.
Simple cortical cysts are noted at left kidney.
No aggressive bony lesion.
1.8.0cm aortic arch aneurysm distal to the origin of left subclavian artery. Mixed hyper- and hypo-dense intra-mural density, suspicious of subacute intra-mural hematoma. No CT evidence of dissection or rupture.
2.Atrophic right kidney with narrowed right renal artery, suspicious of right renal artery stenosis
My grandfather get Thoracic Aortic Aneurysm, After consultant doctor said he didn’t know why aortic aneurysm the extend to 8cm. He only provide two suggestions to us
1.Take drugs only , but he forecast he will 50% chance ‘disappear’ in the year.
2.Surgery. But he warning because my grandfather high blood pressure, heart weakness and poor kidney function. The successful rate around 60-70%only.
I'm not the doctor but want to wish you, your family and your grandfather the very best. I have an aneurysm of the ascending aorta measuring 4.5 cm (as well as aneurysms in the origins of the great vessels) and that's scary enough to deal with. I can't imagine an 8.0 cm., especially when from everything I've read surgery is suggested at 5.0 cm.
Again, positive vibes and all the best in what is a very difficult situation.
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