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Thoracic vs abdominal

Is there anyway a thoracic aneurysm could be missed during an ultrasound for AAA?
25 Responses
Avatar universal
If the thorax was not imaged, yes.
Avatar universal
The usual test for thoracic aneurysms is a CT scan.  Sometimes MRI is chosen, especially in cases that are expected to require repeated monitoring, in order to minimize exposure to ionizing radiation.  Some thoracic aneurysms can be seen on a conventional chest x-ray, but that's not the "gold standard" test by any means.  It's just that a large thoracic aortic aneurysm can often be seen on a chest x-ray, and then usually a CT scan will be ordered for a more detailed image.
Avatar universal
I've also had a chest xray with contrast recently, but it was looked at by a pulmonologist, not a cardiologist, any luck there?
   I heard that you would need a CT without contrast, but i might have misunderstood.
Avatar universal
I've also had a chest xray with contrast recently, but it was looked at by a pulmonologist, not a cardiologist, any luck there?
   I heard that you would need a CT without contrast, but i might have misunderstood.
Avatar universal
Most x-rays are read by a radiologist, even if they are also "read" by the doctor who ordered the x-ray.  I guess the exception to that would be if your pulmonologist took the x-ray at his office and does not have a policy of sending the pics out for a second reading. The radiologist's report is generally more thorough.  You could get the radiologist's report, if there is one, and read that.  If there is any mention in the radiologist's report of aortic enlargement, dilation, or ectasia, there's your answer.  That would mean there's something that's big enough to stand out on a simple chest x-ray.  If the chest x-ray has not been read by a radiologist or if the radiologist's report does not mention anything of the sort, then I think you're back to square one.  Under those circumstances, you don't really know any more than you did to start with, because a chest x-ray is not the definitive test to rule out an aortic aneursym.
Avatar universal
Wait, chest x-ray with contrast?  Did they put the contrast medium in your vein, or was it something that you drank?  If the contrast medium went to your aorta, that should let the docs get a pretty good idea of the size of it.  Sorry, I've just never had that test, so I don't know what structures the contrast medium is designed to enhance. But my advice stands that it would be a good idea to get the radiologist's report.
Avatar universal
I have a copy of the radiologist report, aside from minimal Atelectasis of the base of my right lung, aside from that everything came back normal.

See I have this visible heartbeat all of a sudden. It's not normal, it developed two months after all of this started and it's rhythmic and constant. 24/7 i can literally see something pulsing/bulging out of my epigastric region.   When I exercise it gets way more intense and it literally feels and looks like my heart is going to explode.

I have had an ultrasound done as well, but they were only looking for an AAA. Also worth noting is that when I lay down (like I did for the ultrasound) you can't see the spot.    

This is going to sound stupid but hear me out. None of my doctors know what they're looking at. All but one of them have followed the same pattern, they look at it and say
"I think that's normal."
I then tell them how it's absolutely NOT normal and developed two months into the 6 months that I have been going through this **** and they then say
"Yeah, I've never seen that before."
which has led to me asking them if they've never seen it before why are they telling me it's normal?  If you lift your shirt right now can you see your heart popping out of your chest.

Anyway I'm thinking about getting my heart worked up and poking the area with a needle.  I'm at the point where the only way they're going to take this seriously is if it's something serious.  I want my life back.
Avatar universal
and yes they put the contrast in my vein.  Here's a video of it but it doesn't really do it justice.  http://www.dailymotion.com/video/x13ekyk_pulse-after-20-pushups_lifestyle  It's a little below the scar in the middle of my chest
Avatar universal
chest CT SCAN* with Contrast, not chest X-ray.   Had a barium swallow chest x ray performed recently to rule out a hiatal hernia.
Avatar universal
I haven't sat down and closely perused all of your threads on all of the different forums, but I did see a comment of yours mentioning that a "pulsatile epigastric mass" was identified.  What did the mass consist of?  In other words, what is it, exactly?
Avatar universal
I still don't know. I had one doctor loosely threw that term out there and then went about whatever else he was doing, Since July I have asked every doctor what is causing it and it usually follows this pattern.

I lift my shirt and show them that my heartbeat/pulse is visible and palpable. They say "I think that's normal"
I tell them it's absolutely not normal, my symptoms started in May and that visible pulsing DEVELOPED in July.
They then proceed to say "yeah I've never seen that before."
which has led to me asking them "if you've never seen it before, why would you tell me it's normal? If it's normal, where's yours?"  etc. etc.

It's so frustrating, if I get a suggestion at all it's that it's an aneurysm. I've had an ultrasound to check for an AAA and they did an ultrasound of my heart.  It doesn't protrude when I lay down so I'm thinking maybe that has something to do with why they may have missed it.  Anyway I don't know where to go or who to see anymore. I don't really have the time to check in to a hospital right now but I think that's what needs to be done. I need to be at a research hospital where people are actually going to work on this daily.  I know my body and I know my mind. This isn't anxiety and it's not normal, I can't do any kind of exercise without feeling a pain in that area and I still can't breathe 6 months later in spite of a ton of tests to try and identify what's going on.

I guess also worth mentioning is that I took a Pulmonary Function Test and all of my charts show that I can't inhale correctly.  The line flattens out on the inhale where it should curve/swoop down.  I've had and endoscopy and a bronchoscopy unfortunately no obstruction was found.  

I thought it was going to be a hiatal or paraesophageal hernia for sure but again between the endoscopy, a chest x ray, and a barium swallow chest x-ray that's been ruled out.

I've seen a cardiologist, EKG and Stress test readings were normal, Ultrasound for AAA and Heart also came back normal.

Symptoms:
- April: the end of the month I noticed throat was red, but thought nothing of it
- May: couldn't finish my runs anymore because of trouble breathing, notice throat was still red. Started refluxing food for the first time in my life
- June: Heavy heartbeat, easily feeling winded after minor activities (walking up the stairs, having to carry a fairly light object a short distance, etc)
- July: Visible/Palpable heartbeat develops, bouts of shaky vision begins
- August: Hands become extremely shaky, bouts of internal tremors (not diagnosed, just the best way I can describe it. Occasionally every muscle in my body feels like a vibrating string)
- September - no new physical developments, just a ton of depression over the fact nothing has been solved yet.

Abnormalities
- Red throat was finally diagnosed through biopsy taken during endoscopy as Eosinophilic Esophagitis. It was also after this biopsy that another doctor went back and looked at the very first blood test I had done in May and notice my eosinophils were elevated (on a 1-5 ref range i was at a 9)
- Elevated IgE  (on a 114 or < scale, I'm at 566.  This was taken in September)

I saw an allergist, who swore it was going to be a food allergy. Upon skin tests the only allergy that came up was nuts, but I've known that since I was about 4 years old and have steered clear of them since, so now he's not so sure what's causing it.    I tested for parasites but nothing came up in the stool.    

So after 6 months and every dollar I have, I've basically got nothing.  Seeing as how the root of the eosinophilic esophagitis has yet to be discovered, and my heart is still painfully popping out of my body, I'm feeling pretty down on the situation.  

On top of the frustration of not knowing whether or not this is something serious, whether or not it's something that can be fixed,,,,, the last meeting i had with my pulmonologist she said "This isn't something urgent, you're not dying from this and that should be a relief."    

No it's not, you just told me it's not urgent, which means it's not going to get solved. I'm losing months of my life at a time and you and the rest of them don't really care. I haven't been able to do anything I enjoy without being in pain / severely short of breath since the beginning of May.      I get that it could be worse, but I'm only 25, I'm not really ready to just give up on life, especially without a diagnosis.  

http://www.dailymotion.com/video/x13ekyk_pulse-after-20-pushups_lifestyle


Avatar universal
Do you have an enlarged spleen?  That's an organ that's highly vascular that is in the general area.  I think you've had enough scans that if you had an aortic aneurysm, it would have been noticed by now.  
Avatar universal
how would i find out if spleen was enlarged and what usually causes that?
Avatar universal
An enlarged spleen can be palpated on a physical exam, and it will show up on an abdominal ultrasound, an abdominal CT, or an abdominal MRI.  An enlarged spleen can be associated with many diseases that have symptoms involving multiple organ systems.  Sometimes the liver is enlarged, as well, in conditions that result in an enlarged spleen.  If the spleen and/or liver are enlarged enough, they can put pressure on the diaphragm from below, and you can be restricted from inhaling fully.

http://www.webmd.com/digestive-disorders/enlarged-spleen-causes-symptoms-and-treatments

You might as well get copies of all of your exam notes and all of your test reports, if you have not obtained them already.  You need to be able to make a list of all of the positive findings from your exams and tests, along with a list of all of your symptoms.  Then you take those two lists, written on the same page, to your doctor, and you ask "what could account for these signs and symptoms?"  You structure the question for the doctor.  You make it easy for the doctor to scale down the problem in his or her mind.  You get it down to one question, with all the data on one page.  Then you write down the possibilities that the doctor throws out, and you ask what tests would be required to rule out each disorder.  A lot of those tests, you will already have had, so a lot of things are already ruled out, but you just don't know it.
Avatar universal
Also, the doctor that was sure you were going to have a food allergy?  He may have been on to something.  You can have food intolerances that don't show up on the skin tests that an allergist does.  I know, because I have nonceliac gluten intolerance.  A food intolerance like that, and gluten intolerance is probably the most common one, can cause signs and symptoms that will mimic any disease you can imagine.  
Avatar universal
I have a copy of all reports that I bring everywhere with me. I have highlighted my symptoms and few findings and have asked one pressing question is "why is my heart visible/palpable all of a sudden and how do I fix that?"  followed very closely by "why can't I breath?"
so far no luck


the very few findings so far have a connection with allergies/parasites.  Elevated Eosinophils and IgE in blood, and a biopsy that shows Eosinophilic Esophagitis. That's all they have been able to find so far  
I have an abdominal ultrasound scheduled for later this week, I'll be sure to check that link you sent about enlarged spleen.

He suspected a food allergy because a ton of cases of Eosinophilic Esophagitis are usually linked to a food allergy. However my diet is pretty steady, mainly eggs chicken and some kind of green vegetable with the occassional pizza and bag of cookies thrown in there, only drink water, beer, or whiskey, and those last two are only about once a week.  Back in July before the heart thing started I actually only ate chicken vegetables and eggs for about 4 weeks. Nothing changed, in fact that was when the heart thing started, so in August I went back to drinking and eating whatever I wanted.   How was your gluten intolerance diagnosed?


All of this started basically overnight and I've really tried to focus on what could have caused all of this to start but there's only a couple of things I could come up with (and yes I have mentioned all of these to my Doctors.)

*** Hiking barefoot on Channel Islands, cut my foot open and was walking around out there.  There is a pulmonary virus out there called Hantavirus that all of my Doctors still have not checked for. Given that it's fatal I can see why they don't think it's that but still, I'm surprised none of them even want to rule it out considering everything that's happened.
*** I inhaled sulfur dioxide in Chemistry class about a month before all of this started.  I don't have a sense of smell and I tried to smell a test tube that had that in it.  Not sure if one inhale could cause long term damage but I have heard of RADS so it's worth considering.
*** I ate mushrooms while on antibiotics.  I thought that maybe being on antibiotics (which throws off your good bacteria) could have led to some kind of infection when I ingested them?  

That is everything I can think of before all of this started that could have led to some kind of infection. All doctors have told me it's unlikely any of those incidents contributed to what's going on.  Thanks for all your replies so far skydnsr, I really appreciate it.
Avatar universal
one more consideration:

My apartment is in a very old building (lead paint walls underneath the padding/paint they have put on top of it), there is a ton of dust in this place no matter what I do, and I'm not sure if there's mold in here or not.  I have also mentioned this to Doctors but none have seemed to think it's related.  Is there anyway to test your blood for mycotoxins?   (I've done environmental allergy skin tests, very very mild reaction to mold and dust mites)
Avatar universal
I'll respond first to your question about how my gluten intolerance was diagnosed.  It was a roundabout path that led to that.  I have restless leg syndrome and periodic leg movements in sleep.  From a website, I became aware that these conditions are caused by systemic inflammation.  (It was nothing that the sleep med doctor told me -- he just wanted me to take an anti-Parkinson's drug, which I refused to do, because those drugs tend to make the problem worse in the long run.)  So I started trying to figure out a way to reduce systemic inflammation.  

One of the main reasons that many people have high levels of systemic inflammation is that most of us eat a pretty crappy diet.  I would have said that I was eating well, but according to the book, The Inflammation-Free Diet Plan, by Monica Reinagel, I was eating a lot of things that are inflammatory.  Any kind of grain-based food is inflammatory.  

So I started eating less bread, first of all. Instead of a sandwich with two pieces of bread, I would eat a fold-over sandwich with one piece of bread.  After a week or two of that, I thought maybe I felt a little bit better, so I cut out bread entirely.  After a week or so of that, I was pretty sure I was on the right track, so I cut out pasta also, and I felt even better.  Eventually, I was reading labels to try to avoid hidden gluten, and now I don't consume gluten at all, if I can help it.    

After being gluten-free for about a month, I did gene testing for celiac disease/gluten intolerance and stool testing for anti-gluten antibodies.  I used enterolab.com.  You don't need a doctor's referral to order tests from enterolab.com.  The results were that I have a gene for celiac disease, and I have IgA antibodies in my stool (produced by the gut) to gluten, casein, soy, and yeast.  That means that I should not eat those foods, because my immune system reacts to them, and I get systemic inflammation that produces various symptoms in several different organ systems.

I don't have actual celiac disease, because I don't have the gut damage that is sine qua non for celiac disease.  I have nonceliac gluten intolerance, and I have multiple other food intolerances in addition to gluten intolerance.  I'm still in the early stages of working through all of that, but all kinds of symptoms in addition to sleep symptoms are gradually getting better, and I'm not ever going back to the way I was eating before.

If you have gluten intolerance, it only takes a tiny amount of gluten, every once in a while, to keep the reaction going.  It's not like you have to eat gluten every day or in large amounts.  If you have gluten intolerance, you can easily have other food intolerances, since the original gluten intolerance gets your immune system and your digestive system all messed up.
Avatar universal
I don't think it's a food intolerance, but I haven't actually ruled it out so I guess it can be thrown on the pile.

It's just really weird.  So it's possible that an enlarged spleen could press into my heart and that's why I'm able to see and feel it beating like crazy now?
Avatar universal
ASSUMING the spleen is enlarged, I doubt it has gotten big enough that it would be pressing on your heart.  But the organ itself could be engorged with blood, and that could be what you see pulsating.  It and/or the liver could conceivably be enlarged enough that one or both of them could be putting pressure on the diaphragm from below, which would compress your lungs, which would make it hard for you to take a deep breath.  

It is mere speculation on my part that you have an enlarged spleen.  I was really just ASKING if anyone thinks you have an enlarged spleen.  My mind went there in the process of trying to think of something in the epigastric area that is highly vascularized that could get enlarged and look like it's pulsating under the skin.  You were checked for an abdominal aortic aneurysm, and that was negative, right?  
Avatar universal
yes I had an ultrasound to check for AAA and that came up negative. They also did an ultrasound of the left side of the heart I guess (Two dimensional  echocardiodiagram with Pulsed Wave and Color Doppler Analysis) "check left ventricular function and valves"  all came back normal.

I'm pretty sure it's my heart that I'm seeing pulsating. When I had the chest xray done he told me to put my fingers over where it was pulsing and it was directly over the bottom of my heart (could see it on the xray).  I know you're just speculating too, but I appreciate it. I can't stand this anymore it's so depressing not being able to breathe and having to look at my heart going insane without a diagnosis after all these months
Avatar universal
can a Thoracic aortic aneurysm be see in a back X-Ray?  I am having severe leg issues.  Can not walk across a parking lot without stopping from severe pain.  Seen the doctor and sent me to a orthopedic doctor thinking it was something in my hips.  Orthopedic doctor did not see anything in the hip X-rays, but did extensive back X-Rays in his office.  He showed me a large spot on the X-Ray that was completely whited out.  He pointed out the spine and next to the spine was the aorta artery where the large spot was completely white?  He stated that it is definitely a vascular issue.  I have had people inform me that he would not be able to tell by a standard x-ray that there is any sort of blockage issue?  Does anyone have any idea if this is true or not?
Avatar universal
I would take the orthopedist's word for it.  Even though he's not a vascular specialist, he reads x-rays for a living.  There may be some calcification in that area of the aorta, which would make it show up whiter.  I would follow up on that and see if it needs medical attention.  If the orthopedist gave you a suggestion as to who to see next, you already know where to go, and if he did not, I would go back to the doctor who sent me to the orthopedist and get a referral to a specialist for the aorta.  Good luck.
Avatar universal
Did you manage to find out anything? I've been going through exactly the same thing for last 6-8 months and it's very frustrating. The only definite diagnosis that I have is a small hiatus hernia and esophagitis. But the pulsation is still there.
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