Caceres’ Corner Case 156 (Update: Solution)

Dear Friends,

Today we are presenting a routine control radiograph of a 31-year-old woman. Can you guess the reason for the operation?

Check the image below, leave your thoughts in the comments section, and come back on Friday for the answer.

1. Aortic coarctation
2. Aortic dissection
3. Congenital aortic valvular stenosis
4. None of the above

Click here for the answer to case #156

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    Mar 2017
    DISCUSSION 8 Comments

    8 Responses to : Caceres’ Corner Case 156 (Update: Solution)

    1. Mauro says:

      This patient had an aortic valve replacement. I can see that the aorta is enlarged. Putting everything together, I think this patient could have Marfan Syndrome and the valve disease was probably regurgitation.

    2. MK says:

      Metallic aortic a valve.
      Elongated descended aorta
      Middle sternotomy
      Metallic suture in left apical region

      Aortic coarctation is not a good idea because of the dilatation of the descended aorta.
      For aortic valvular stenosis the ascend aorta is not diltated
      Perhaps the apical left suture is because of a bulla surgery (but there are not loss of volume), and the leptosomic thorax appearance would be more factores to think in Marfan syndrome, like Mauro.

    3. Genchi Bari Italia says:

      ….PROF !!!!! Questo non può’ essere il cuore “nativo”…..è’ troppo piccolo…..questo è’ un cuore “trapiantato”….. attento a Dybala…..sara’ il vostro incubo !

      • jose caceres says:

        It is not common to have a prosthetic valve in a transplanted heart.
        If I were you, I would worry about
        Messi, Neymar and Suarez.

    4. 19Medicus83 says:

      Hello professor!
      My findings are as nearly all are already mentioned:
      – middle sternotomy, second and last cerclage are (partly) broken
      – metallic aortic valve replacement
      – surgical seam in the left apical lung region
      – normal, rather small configurated heart
      – double contour of the aortic knob and kinking of the descendens aorta
      – prominent pulmonary trunk with an outlining contour projected over it
      – both lungs and hila look normal

      Interpretation seems a little bit difficult for me. Keeping the double contour of the aortic knob in mind I suppose the patient had an typ a dissection affecting the aortiv valve. Consecutively, aortiv valve replacement was needed. Marfan syndrome as the underlying disease seems quite likely.

    5. Parviz says:

      Non of the above

    6. Andy says:

      I was checking the case again, as it was my first time participating.
      Is not usual to find an ao valv replacement ONLY with a type A dissection…
      So, i couldnt make 1 dg…

    7. Deresh Natali says:

      I think answer 1. Aortic coarctation: figure of 3 sign, inferior rib notching. often in association with hypoplasia of the aortic valve (bicuspid aortic valve most common associated defect), probably because it was held prosthetics.