0:01

So I'm going to show you a case to illustrate

0:04

the importance of doing cardiac studies and,

0:10

um, thinking about cardiac pathology and

0:13

extracardiac situations, which is what this is.

0:18

So this patient came in with symptoms.

0:23

Let's see if you can guess.

0:26

Here is the abdominal aorta.

0:30

And this is the right common iliac artery.

0:33

And look at the left.

0:35

It's gone.

0:36

So, occlusion of the left common

0:40

iliac artery, although it came in with

0:44

leg pain and diminished pulse.

0:49

And then you'll also notice that the inferior

0:54

mesenteric artery, which comes off here, goes.

0:58

And the bowel,

1:03

it's a little thickened, some haziness.

1:07

Thanks.

1:07

Sort of the bowel ischemia, and

1:14

probably not that evident is that some

1:16

of the SMA branches have gone as well.

1:19

Any case, so you have multiple arterial occlusions,

1:24

and in that situation, particularly

1:29

in the young patient, notice the

1:30

relative absence of atherosclerosis.

1:34

It doesn't look like it's an atherosclerotic stuff.

1:37

It's important to look at the heart.

1:42

So, as you're looking at the

1:45

heart, what are you looking for?

1:47

You're looking for something in the left atrial

1:50

appendage, such as thrombus, maybe a shunt

1:55

that could have led to a paroxysmal embolus.

1:58

This patient has this atrial appendage.

2:02

Abnormality here in the proximal descending aorta,

2:04

a bulge, which is from previous coarctation repair.

2:08

Um, left occluded, although

2:11

that might have been chronic.

2:13

And very easy to miss

2:17

is this abnormality here.

2:21

Very easy to miss.

2:25

It's globular.

2:27

Doesn't look like a mixing

2:28

artifact, looks like it has form.

2:30

So it's a vegetation.

2:33

It's a vegetation on the mitral valve.

2:37

So this patient has endocarditis.

2:40

Thanks.

2:40

Thanks.

2:41

With dislodgement of the vegetation, infected

2:48

vegetation, into the lower extremities.

2:53

Something that can easily be missed

2:55

unless one diligently looks for them.

3:01

Up to now, endocarditis has been the

3:03

domain of echocardiogram and you don't

3:06

get a CT scan to look for vegetations.

3:09

But you often find it because the sort of pathology

3:13

that people get, with endocarditis, the kind

3:16

of diffuse, low-grade, nonspecific symptoms.

3:22

People get CT scans for them, so they'll often be

3:26

seen because of the nature of the presentation and

3:30

the nature of the test ordering for the presentation.

3:34

Thank you.