Vascular Ring in an Adolescent Patient with Nausea and ...
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Lehigh Valley Health Network LVHN Scholarly Works Department of Pediatrics Vascular Ring in an Adolescent Patient with Nausea and Mild Dysphagia Kristen Kametz CRNP Lehigh Valley Health Network, [email protected] Follow this and additional works at: hp://scholarlyworks.lvhn.org/pediatrics Part of the Pediatrics Commons is Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact [email protected]. Published In/Presented At Kametz, K. (2015, October 7). Vascular Ring in an Adolescent Patient with Nausea and Mild Dysphagia. Poster presented at: National Conference for NASPGHAN (North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Washington, DC.
Transcript of Vascular Ring in an Adolescent Patient with Nausea and ...
Lehigh Valley Health NetworkLVHN Scholarly Works
Department of Pediatrics
Vascular Ring in an Adolescent Patient with Nauseaand Mild DysphagiaKristen Kametz CRNPLehigh Valley Health Network, [email protected]
Follow this and additional works at: http://scholarlyworks.lvhn.org/pediatrics
Part of the Pediatrics Commons
This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact [email protected].
Published In/Presented AtKametz, K. (2015, October 7). Vascular Ring in an Adolescent Patient with Nausea and Mild Dysphagia. Poster presented at: NationalConference for NASPGHAN (North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Washington, DC.
Case Presentation Discussion
•Vascularringsaregeneticanomaliesthatpresentininfantswithrespiratorydifficultiesandabnormalities,buttheyshouldalsobeconsideredwhenapatientpresentswithpersistentnauseaandvomitingatanyage.
•Itisimportanttodothoroughhistorytakingwhenseeingapatientinordertodeterminetheappropriatetesting
© 2015 Lehigh Valley Health Network
Conclusions
•Vascularringsshouldbeconsideredpartofthedifferentialforpatientsofallageswhopresentwithpersistentnauseaand/orvomiting.
•Oralcontraststudiessuchasabariumesophagramareanimportanttestindetermininganatomicabnormalitiesinpatients.
•13yroldotherwisehealthymalepresentedtotheclinicwith8monthsofearlymorningnauseaandintermittentnon-bloody,non-biliousemesis.Symptomswerenotassociatedwithfoodoractivity.Complaintofmilddysphagiawithbreads,butotherwisepatientdeniedabdominalpain,dyspepsia,abnormalbowelmovements,weightlossorchangeinappetite.
•Patientwasplacedonomeprazole20mgoncedailywithmildimprovementofnausea.
•Labsobtained-TTGIGA,IGA,TSH,T4,lipase,amylase,chemistrypanel,completebloodcountandsedimentationratewereallunremarkable.
•BariumEsophagramshowing:Right-sidedaorticarchwithaberrantleftsubclavianartery.Otherwise,normalesophagus,stomach,andduodenum.
•CardiacMRI–withandwithoutIVcontrastshowedrightaorticarchwithaberrantleftsubclavianarteryoriginatingfromaretroesophagealdiverticulum.Thisanatomicsubstrateconstitutesavascularring.Thereisassociatednarrowingatthelevelofthering.Thereisalsonarrowingoftherightmainstembronchusasitcoursesunderneaththerightaorticarch.
•Cardiothoracicsurgeryultimatelyperformedthoracicsurgerytolitigatethering.
•Aftersurgerypatientdeniesgastrointestinalcomplaints,includingnauseaandvomiting.Henolongerrequiresmedication.
Introduction•Vascularringsareacongenitalanomalythatcancausegastrointestinalandrespiratorysymptomsduetocompressionofthe
esophagusandtrachea.Thevascularringcancomprisearightsidedaorticarch,leftsubclavianarteryandaleftligamentum.•Itisararecauseofdysphagiainadolescentpatients.
Imaging
BariumEsophagram
Pediatric Gastroenterology, Children’s Hospital of Lehigh Valley Hospital and Health Network, Allentown, PA
Vascular Ring in an Adolescent Patient with Nausea and Mild Dysphagia Kristen Kametz, CRNP
