0:00

So this next case is an interesting case.

0:03

It'll be hard for me to make completely pretty pictures

0:06

here, but you don't really need them.

0:08

So this is a case where, um,

0:10

unexpected findings were identified, uh, on a patient

0:14

with a history of a bypass graft,

0:16

but also of an aortic aneurysm.

0:18

But the, those were not the most interesting

0:20

or the most unique features here.

0:22

So just quickly, we do have an ascending aortic aneurysm.

0:25

Uh, never a good thing. Um, and there's a dissection.

0:29

Um, so it's a dissected aneurysm that was, um, imaged

0:33

and you, if you're gonna do a measurement, you want to go

0:36

and double oblique short axis.

0:37

So just make sure you're not exaggerating the size.

0:40

Pretty big, um, aneurysm

0:41

that had the feared complication of dissection.

0:44

But I also wanted to just show you that, um,

0:47

as your eye has probably been drawn to, you do have a lima

0:52

in place and you also have this, uh,

0:55

saphenous vein graft aneurysm.

0:57

So similar to the mo recent case we looked at with the, uh,

1:01

known aneurysm, you wanna measure it,

1:03

and it's worth mentioning that if you were

1:06

to do a cardiac cath, you could miss this altogether.

1:09

Um, the reason is that the cath only sees the lumin.

1:12

We call it lumin or Lumino Graham.

1:14

Uh, but the CT can really show you the vessel wall.

1:18

Uh, so this one was measured at up

1:21

to 2.6 centimeters, so probably, I'll just start here.

1:25

I think I'm a little oblique, but no, pretty similar there.

1:28

And, uh, just like in the abdominal aorta,

1:31

you wanna include the vessel wall.

1:33

Uh, and in this case also, if I were reading it,

1:36

I would give it, uh, an additional code of exception

1:38

for both the aneurysm and also the aortic aneurysm

1:41

with dissection in the ascending aorta.

1:44

So an interesting case, um, this is a non gated sequence.

1:47

We used it to screen everything through.

1:49

Um, but you can also look at the, uh, wall motion

1:53

and wall thicknesses.

1:55

I'm just gonna pull over just one phase of the, uh, scan.

1:58

This was not done with ECG gating,

2:00

but, um, one thing you could look at is, uh,

2:03

the wall thicknesses.

2:04

And you can see in this case just a nice example of a, uh,

2:09

little bit of thinning of the apical inferior wall.

2:12

So that, uh, indicates a likely

2:15

or remote myocardial infarction.

2:17

Very focal and segmental,

2:18

but patient with a lot of disease, including dissection

2:21

of the aorta and aneurysm of the venous bypass graft.