1/18. dyspnea lusoria: compression of the pulmonary artery by a Kommerell's diverticulum.We report a rare case of Kommerell's diverticulum presenting as dyspnea on exertion. After careful physical examination, selective imaging tests demonstrated a significant flow abnormality in the left pulmonary artery caused by an aneurysm of the descending aorta in the area of the ligamentum arteriosum.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/18. Midaortic syndrome associated with fetal alcohol syndrome.Midaortic syndrome (MAS) is an uncommon condition characterized by progressive narrowing of the abdominal aorta and its branches and impressive formation of collateral circulation. It affects children and young adults and presents predominantly as untreatable hypertension. Fetal alcohol syndrome (FAS) refers to a constellation of physical, behavioral, and cognitive abnormalities secondary to alcohol exposure in utero. The authors present an unusual association between a hypoplastic abdominal aorta and fetal alcohol syndrome. The patient discussed in this article presented with severe hypertension that was successfully treated with renal angioplasty.- - - - - - - - - - ranking = 0.070025216471862keywords = physical (Clic here for more details about this article) |
3/18. Aortic saddle embolus presenting with transient lower extremity paresthesia.We report the case of a 58-year-old woman who developed acute onset of bilateral lower-extremity numbness and difficulty ambulating at home. On presentation to the emergency department, however, the patient's symptoms essentially had resolved. An aortic saddle embolus was suspected based on the patient's cardiac history and the absence of distal pulses in the lower extremities. This case illustrates that even with vague or resolving complaints, a high index of suspicion should be maintained for the diagnosis of aortic saddle embolus based on the patient's medical history and on physical examination.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/18. High output heart failure 8 months after an acquired arteriovenous fistula.Congestive heart failure (CHF) due to hyperkinetic states can occur in systemic diseases and in arteriovenous fistulas. An 18 year old Turkish male patient complaining of dyspnea and palpitations, who had suffered a stab wound to his abdomen eight months earlier, was admitted to our clinic. auscultation revealed a systolodiastolic murmur over the entire abdomen. Chest x-rays demonstrated significant cardiomegaly. echocardiography revealed biatrial enlargement and significant mitral and tricuspid regurgitation accompanied by dilatation of the inferior vena cava. Right heart catheterization showed increased oxygen saturation at the inferior vena cava. A diagnosis of an aortocaval fistula was made by aortography. The symptoms subsided and valvular regurgitations ceased alter surgical correction. This rare case demonstrates the significance of routine physical examination and history of the patient.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/18. Aortic flap valve presenting as neurogenic claudication: a case report.STUDY DESIGN: A case report of a patient who presented with pain in both lower limbs related with walking and standing as a result of an unusual vascular etiology. OBJECTIVES: To describe the pathology and treatment of an unusual case of vascular claudication. SUMMARY OF BACKGROUND DATA: Symptoms of neurogenic claudication may be mimicked by intermittent vascular claudication. Not infrequently, arterial disease coexists with spinal canal stenosis. Determination of correct diagnosis is the prerequisite for effective treatment. methods: The patient was a 64-year-old woman who presented with bilateral buttock pain spreading to the calves. The symptom was related to walking and climbing stairs and relieved by sitting down. MRI of the lumbosacral spine corroborated severe spinal stenosis at L3-L4 and L4-L5. Based on findings on physical examination of the peripheral pulses, an aortogram revealed a flap in the lumen functioning like a valve as the cause of her lower limb ischemic pain. RESULTS: The patient was managed by insertion of a self-expandable metallic stent with complete resolution of her symptoms. CONCLUSIONS: We report a case that was diagnosed as neurogenic claudication on clinical features and MRI evidence. However, subsequent to an aortogram the diagnosis was revised. intermittent claudication is often difficult to distinguish from neurogenic claudication. There are no sensitive discriminators based on history alone. In the presence of poor or absent peripheral pulses, an arteriogram is necessary to ascertain the relative importance of the peripheral arterial circulation.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/18. Clinical and echocardiographic features of aorto-atrial fistulas.Aorto-atrial fistulas (AAF) are rare but important pathophysiologic conditions of the aorta and have varied presentations such as acute pulmonary edema, chronic heart failure and incidental detection of the fistula. A variety of mechanisms such as aortic dissection, endocarditis with pseudoaneurysm formation, post surgical scenarios or trauma may precipitate the fistula formation. With increasing survival of patients, particularly following complex aortic reconstructive surgeries and redo valve surgeries, recognition of this complication, its clinical features and echocardiographic diagnosis is important. Since physical exam in this condition may be misleading, echocardiography serves as the cornerstone for diagnosis. The case below illustrates aorto-left atrial fistula formation following redo aortic valve surgery with slowly progressive symptoms of heart failure. A brief review of the existing literature of this entity is presented including emphasis on echocardiographic diagnosis and treatment.- - - - - - - - - - ranking = 0.070025216471862keywords = physical (Clic here for more details about this article) |
7/18. A syndrome of widened medullary cavities of bone, aortic calcification, abnormal dentition, and muscular weakness (the Singleton-Merten syndrome).Two patients with clinical and radiological features similar to those of Singleton and Merten's patients are described. These patients exhibit features of a unique clinical syndrome of unknown etiology: generalized muscular weakness with secondary hip and foot deformities, progressive calcification of the thoracic aorta beginning in childhood, calcific aortic stenosis leading to heart failure, dysplasia of the teeth, poor physical development, osteoporosis, expanded medullary cavities of the metacarpal and metatarsal bones, and chronic psoriaform skin lesions.- - - - - - - - - - ranking = 0.070025216471862keywords = physical (Clic here for more details about this article) |
8/18. Primary aortoduodenal fistula. Case presentation and review of literature.One hundred and twelve cases of primary aortoduodenal fistulas were reviewed. The most common etiological agent was an atherosclerotic infrarenal abdominal aortic aneurysm. There was a male to female predominance of 9:2 with an average age of 62 years. Most fistulas occurred between an infrarenal aneurysm and the third portion of the duodenum because of the relatively fixed position of the duodenum and its direct anatomical relationship posteriorly with the aorta. Patient symptoms may vary from abdominal or back pain with gastro-intestinal bleeding to just hematemesis or melena. Twenty per cent gave a history of abdominal aneurysm while up to 70% may have an abdominal mass on physical examination at the time of admission. Tentative diagnosis is established by history and physical examination with duodenoscopy, barium duodenogram and angiography available only if temporally feasible. Surgical exploration is the only treatment with resection of the aneurysm, synthetic graft placement and duodenal suturing as the procedure of choice.- - - - - - - - - - ranking = 2keywords = physical examination, physical (Clic here for more details about this article) |
9/18. Intermittent aortic-graft obstruction secondary to anastomotic aneurysms.diagnosis of anastomotic aneurysms is usually suggested by simple palpation of a pulsatile mass on physical examination. diagnosis may be more difficult, and clinical appearance more unusual, for those aneurysms occurring in an intra-abdominal location. This article reports an unusual manifestation of bilateral iliac-artery false aneurysms, ie, intermittent obstruction of aortic-graft blood flow. Femoral pulses were absent and significant peripheral ischemia present with the patient's legs extended. Femoral pulses returned to normal with the patient's legs flexed. Perianastomotic fibrosis, the mass effect of the false aneurysms, and possible kinking of the partially disrupted suture line with tensing of the psoas muscle on extension of the legs are possible causes of the intermittent obstruction to blood flow. The varied clinical manifestations and general principles of operative repair of anastomotic aneurysms are described.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
10/18. Atherosclerotic coarctation of the abdominal aorta in women.In the ten year interval from 1967 to 1976, in a group of 200 patients with aortoiliac occlusive disease, six were identified who presented a unique combination of physical findings, angiographic abnormalities and pathologic changes. Atherosclerotic coarctation describes this entity because of the discreteness of the lesion found, the extent to which the aorta is occluded and the presence of extensive collaterals. Pathologically, the lesion is an organized thrombus forming on a single ulcerated plaque in an aorta with a lumen that is otherwise well preserved. Distally, infantile vessels are found. Other features have been the absence of diabetes mellitus and the fact that all of these patients have been women. All but one patient smoked cigarettes. Local endarterectomy restored pedal pulses and provided lasting relief of symptoms in all of the patients.- - - - - - - - - - ranking = 0.070025216471862keywords = physical (Clic here for more details about this article) |
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