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  #1  
Old 11-11-2011
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Vascular Diminished Pulses and Widened Mediastinum!

50 year old male developed a sudden pain in chest & back. Physical examination revealed diminished radial pulses bilaterally & normal femoral pulses. The chest x-ray revealed widened mediastinum which of the following underlying conditions is most likely to be etiologically related to this patient acute problem?
a. a history of DM
b. myxoid change and fragmentation of elastic lamellae in aortic media
c. sever atherosclerosis of proximal aorta
d. a past history of syphilis
e. a congenital heart malformation
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Old 11-11-2011
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hmmm. is it C?
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Old 11-11-2011
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chest x-ray revealed widened mediastinum means case of aortic disection
diminshed radial pulses bilaterally & normal femoral pulses.

c. sever atherosclerosis of proximal aorta i think
since it is acute case not chronic i exclude (DM .congental .syphilis )
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wil ATh cause acute dissection ???
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is it B?
atherosclerosis is the risk factor for aortic aneurysm not dissection.
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Old 11-11-2011
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Correct Answer the correct answer is > B

this is a case of aortic dissection and was complicated causing cystic medial necrosis which is damage to elastic lamellae and accumulation of matrix material collects in the tunica media and the widening of the chest x-ray due to the cardiac temponade which is also complication of dissection and is the most common cause of death in aortic dissection ,, thanks everybody
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Is anyone know the reason for diminished radial pulses and normal femoral pulse? Thanks!
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Old 11-11-2011
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Default Aortic Dissection

Dissecting blood enters and causes compression (constriction of lumen) of proximal parts of aortic branches that is why in both upper extremities the pulse is diminished.

Diminished Pulses and Widened Mediastinum!-nic_k201_014.jpg
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  #9  
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Quote:
Originally Posted by belindalimm View Post
Is anyone know the reason for diminished radial pulses and normal femoral pulse? Thanks!
what i know to cause a diminshed of even loss of radial pulse while femoral is normal is cervical rib ,, there must be other causes but that what come to my mind
if it was opposite as normal radial pulses & deminished femoral it would be easier as aortic coarction do that ,, wish that helps alittle
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Quote:
Originally Posted by menatallah Elgohary View Post
what i know to cause a diminshed of even loss of radial pulse while femoral is normal is cervical rib ,, there must be other causes but that what come to my mind
if it was opposite as normal radial pulses & deminished femoral it would be easier as aortic coarction do that ,, wish that helps alittle
Thank you! By the way, what is cervical rib? Is it the narrow park of a rib?
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Old 09-12-2012
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Yes the answer is B
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Old 09-13-2012
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Quote:
Originally Posted by belindalimm View Post
Thank you! By the way, what is cervical rib? Is it the narrow park of a rib?
Certvical rib arises from C7 vertebra might lead to Thoracic Outlet syndrome
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