Male patient 38yo with sputum cough, loss of weight #10kg, no fever, no abdominal pain, loss appetite for 2 months without trouble of passing out of water and waste.
Gastroendoscopy shows gastritis and esophagitis
due to Candida.
Normal chest-X-Ray.
MSCT of chest and abdomen detected dissecting
IAA from lower kidney part to left iliac artery while AA diameter suprarenal =21mm and infrarenal =22mm
Enlarged lymph nodes at both 2 lung hilii, mediastinal, left axillary nodes;
and in abdomen, lymph nodes of celiac artery, nearby
pancreatic head, and periaotic in epigastric area.
Thought about lymphoma infiltrating nodes.
POC Ultrasound findings= Splenohepatomegalies
and enlarged nodes of celiac artery, nearby
pancreatic head, and periaotic in epigastric area.
Thank to MSCT results, POCUS showed a dissecting isolated abdominal
aorta, d# 25 x 18mm from lower kidney to aortic bifurcation, which has two lumens, right lumen with Doppler flow and no flow
in left lumen. Right and left iliac arteries with normal
lumen and Doppler flow.
Neck ultrasound shows left side neck nodes, poor
echogeneicity, loss of nodal hilus, no calcification
nor necrosis sign.
Nothing abnormal on thyroid scanning.
Lab tests = Slight anemia,Hb=11.4g/dL. Leucocytes= 8.95x10^9/L, normal FBG= 4.77 mmol/L, HP Test-IgM - IgG (Elisa) negative; β2 Microglobulin = 4250 μg/L; HIV Elisa (+).
Biospy of neck nodes and histopathologic result=
Loss structure of node. Many small, medium and big size cellules in vessels with high endothelial cells, hyalinized vessel walls.
Many eosinophyl leucocytes, cytoplasms and
epitheloid hystiocytes in the base.
Suspect T lymphoma on node specimen.
Conclusions=
1/ Pay attention of dissecting isolated abdominal aorta may exist in young patient.
2/ Complete examination and using all imaging
diagnostic modalities may help detecting
patient of risks and his/her illness.
Reference:
Isolated Abdominal Aorta Dissection,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3926414/