Menaka Nadar, MD

University of Virginia

CC: abdominal pain, nausea

• HPI: 80 year old female with multiple medical comorbidites with right upper quadrant abdominal pain and sudden, overwhelming feeling of nausea. Managed symptoms at home for one week. Finally presented to primary care physician and was sent to the ER.

PMH• Atrial fibrillation• Severe pulmonary

hypertension with moderate RV dysfunction

• Hypertension• Hyperlipidemia• Diabetes Mellitus Type 2• Obesity

PSH• No prior cardiovascular

surgery

Medications• Coumadin for atrial

fibrillation– INR 1.7 on admission

• Amiodarone• Cardizem• Coreg• Lasix• Losartan• Onglyza• Levemir

Allergies• None

Imaging

Diagnosis/Discussion

• 80 year old female with symptomatic contained rupture of distal descending thoracic aortic penetrating ulcer– Ulcer 2cm above the celiac artery

Potential Complications

• Endoleak• Stent migration• Stent fracture• Infection• Bleeding• Stroke• Myocardial infarction• Acute kidney injury

Intervention

PseudoaneurysmStatus post stenting

Summary

• 80 year old female with symptomatic contained rupture of descending thoracic penetrating aortic ulcer successfully treated with endovascular stent graft.