Aortic aneurysm with paravertebral collection

Ms. Umarani1*, Ms. Josephine Angle2, Ms. Baranika3

1Assistant Nursing Superintendent, Kauvery Heartcity, Trichy, India

2Non Critical Ward Senior Staff Nurse, Kauvery Heartcity, Trichy, India

3Non Critical Ward Senior Staff Nurse, Kauvery Heartcity, Trichy, India

*Correspondence: M: +91 8508698000, email: [email protected]

Abstract

The aorta is the largest artery in your body. It carries blood and oxygen from your heart to other parts of your body. It’s shaped like a curved candy cane. Your ascending aorta leads up from your heart. Your descending aorta travels back down into your abdomen (belly).

An aneurysm can develop in any artery. An aortic aneurysm develops when there’s a weakness in the wall of your aorta. The pressure of blood pumping through the artery causes a balloon-like bulge in the weak area of your aorta. This bulge is called an aortic aneurysm. In this article, we talk about a patient with aortic aneurysm treated at our hospital.

Case Presentation

A 48 years old lady, came to the hospital with the complaint of fever and back pain since 15 days. The pain was severe in middle of her spine. Her reports and imaging film was reviewed.

Patient was presented with the following signs and symptoms.

Symptoms

  1. Difficulty breathing
  2. Fever
  3. Back pain (Severe)
  4. Drowsiness

 

Clinical Signs

  1. Pulsatile mass felt
  2. Bulging of Para spinal line

Findings

  1. There was a small outpouching from the DTA (saccular aneurysm), which was present amidst the paravertebral collection.
  2. Fever workup was performed (Blood & urine), which turned out to be sterile.
  3. Her CRP was elevated (201) and her TLC was 18000 at admission.
  4. Her Mantoux was negative at the end of 48 hours.
  5. Aspiration from the paravertebral collection was contemplated either under CT guidance or thoracoscopy or mini thoracotomy with the concerned consultants

Based on all the investigations and its results, we got the cardiologists and general physician opinions.

Orthopedician Opinion

The orthopedic consultants opined that the lesion was unlikely to be tuberculosis as the vertebrae and intervertebral disc space were unevolved. An extensive evaluation for vegetation’s turned out to be negative.

Cardiologist and General Physician Opinion

They evaluated her extensively and opined that the clinical picture and the findings were in favor of Meliodosis. He further suggested the antibiotic to be changed to Inj. Meropenem 2 gm IV Q8H along with Bactrim DS (Trimethoprim-Sulfamethoxazole).

Investigation Findings

ECG Report: No diagnostic features except borderline Left Axis Deviation

 

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ECHO Report: Left Ventricular Hypertrophy

 

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CT Chest and Abdomen Angiography

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MRI – Dorsal Spine:

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CT Chest and Abdomen Report

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Diagnosis

  1. Saccular Aneurysm of the descending thoracic aorta (DTA)
  2. Paravertebral Abscess
  3. Newly detected Type II DM

Treatment

  1. Patient treated with the antibiotic Inj. Meropenem, 2gm IV Q8H along with Bactrim DS (Trimethoprim-Sulfamethoxazole).
  2. Then the patient gradually improved, she was afebrile and she was able to ambulate with minimal assistance and her symptoms were reduced by more than 50%.
  3. She was plan for surgical exploration and drainage later (after stabilization).
  4. At the time of discharge, her CRP was 48 from 201 and her TLC was 11700 from 18500.

Discussion

  1. An aortic aneurysm is a balloon like bulge in the aorta, the large artery that carries blood from the heart through the chest and torso. Risk Factors includes, High blood pressure, High blood cholesterol and Atherosclerosis (Hardened arteries).

 

  1. Early Symptoms;
  1. Difficulty in breathing or shortness of breath.
  2. Feeling full even after a small meal.
  3. Pain whenever the aneurysm is growing (could be in the neck, back, chest or abdomen).
  4. Pain or difficulty while swallowing.
  5. Swelling of arms, neck or face.
  1. Diagnosis;
  1. Detection of the presence of desmosine, an amino acid that diseased aortas release into the blood and urine.
  2. Basic Hematology is useful.
  3. Investigations of choice is ultrasound.
  4. Chest X-Ray.
  5. Electrocardiogram.
  6. Computed tomography (CT) of the chest and abdomen pelvis.
  1. Treatment;
  1. Depending on the cause or size of the aortic aneurysm.
  2. Rupture or dissection of an aneurysm may require emergency surgery.
  3. Open surgical repair is the most common surgery, Endovascular Aneurysm Repair (EVAR) is done by cardiac catheterization and is less invasive than open surgical repair.

Nursing Assessment

  • Patient with abdominal aortic aneurysm will have symptoms like a pulsating feeling near the navel, deep constant pain in the abdomen or on the side of the abdomen and back pain.
  • Patient with thoracic aortic aneurysm will have symptoms like tenderness or pain in the chest, back pain, shortness of breath or trouble breathing or swallowing, coughing possibly with blood and hoarseness.

Nursing Management

Patient with aortic aneurysm are commonly managed with nursing care measures such as:

  1. Reducing fear and anxiety
  2. Assess the anxiety level (Mild, Severe)
  3. Acknowledge awareness of the client’s anxiety
  4. Provide a quiet, private place for significant wait.
  5. Reduce unnecessary external stimuli
  6. Assess for signs of myocardial ischemia (chest pain, tachycardia or ST –segment and T-wave changes).
  7. Monitor for signs of decreasing cardiac output Tachycardia and restlessness.

Conclusion

Patient was discharged with the following advice

  • To have control over high blood pressure
  • To avoid tobacco
  • To watch for back pain, abdomen pain, abdomen pain breathing difficulty.
  • To take drugs as per doctors.

Discharge Medications

S. No

Drugs

Dose

Frequency
1 Inj. Meropenem 1gm 1-1-1 × 2 Weeks
2 Tab. Tamin 1gm 1-1-1
3 Tab. Tramadol 50mg 1-0-1 (SOS)
4 Tab. Pantocid 40mg 1-0-1
5 Tab. Trigabantin 100mg 1-0-1

General physician advice

  • Tab.Bactrim DS – 1-0-1
  • Tab.Folvite 5mg – 1-0-0

 

Dermatologist Advice:

 

  • Miconazole Nitrate DK Gel – Twice daily

DM Advice

  1. Inj. Human Actrapid S/C – 145U-14U-0
  2. Inj. Human Mixtard 30/70  S/C – 0-0-16U
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Ms. Umarani

Assistant Nursing Superintendent

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Ms. Josephine Angel

Senior Staff Nurse

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Ms. Baranika

Senior Staff Nurse

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