October Case of the Month

Access case here.

Authors: Katie Davis, DO, Resident Physician, Diagnostic Radiology,Department of Radiology,MetroHealth Medical Center, Cleveland, Oh.; Vikas Jain, MD, Assistant Professor, Assistant Program Director, Diagnostic Radiology, Neurology, Department of Radiology, MetroHealth Medical Center, Cleveland, Oh.

Why did you select this case for submission?

I selected this case for submission because it emphasizes the difference between impending rupture, contained rupture, and rupture of abdominal aneurysms. Distinguishing between these entities is important for clinical care.

What should readers learn from this case?

Although there is some overlap regarding the radiographic signs of contained rupture and rupture of abdominal aortic aneurysms, prompt recognition of contained abdominal rupture is critical to decreasing the overall patient morbidity and mortality, as there is a benefit from preoperative assessment and urgent surgery rather than emergent surgery.

What did you learn from working on the case?

I learned about the “draping aorta” sign, which is an indicator of aortic wall insufficiency. It is defined as an irregular contour of the posterolateral wall of the aorta, which is not identifiable as distinct from adjacent structures. The posterolateral wall of the aorta will closely follow the contour of the adjacent vertebral bodies.

How did guidance from senior staff at your institution impact your learning and case development?

The guidance from senior staff supplemented and enriched my understanding of the pathologies affecting abdominal aortic aneurysms.

Why did you choose Case in Point for submission of your case?

I submitted a case to Case In Point once before, so I felt very comfortable with the submission requirements and the format.

What is the appeal of online learning, like Case in Point, as opposed to other learning venues, such as print?

Gone are the days of card catalogs and heading to the library in the hopes that a radiology text will be available! Online learning is an easily accessible, time-efficient, and more cost-effective option for residents.

Are you a regular reader of Case in Point? What are your favorite types of cases?

 I am a regular reader of Case in Point. My favorite types of cases are those relating to women's health issues. 

What else should we know about the case that you'd like to share?

This case came across our board as an outpatient study. We were able to quickly diagnose the entity and coordinate vascular surgery referral with the primary provider. The patient underwent surgery and did well!

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