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Case submitted by Jonathan Frankel, MD, and Thomas J. Learch, MD.
- 86 year old male presents to the ED after a fall at home. He was in the bathroom when he suddenly became lightheaded and fell. He was noted by the paramedics at the scene to be hypotensive (80s/60s). No focal weakness. No recent illness.
Past Surgical History: laparoscopic hernia repair, retropubic prostatectomy
Family Medical History: Mother and brother stroke; Father prostate cancer
Social History: Daily smoker since 1979
- Patient remained hypotensive with systolic blood pressure gradually dropping into the high 60s.
- His breathing was labored and tachypneic.
- INR = 1.3
- PTT = 29
- Hgb/Hct = 9.4/29.4 (11.9/40.0 [baseline in 2014])
- Lactate = 4.3
- Tbili = 1.9
What's the diagnosis?
- Aortic dissection
- Aortic aneurysm
- Aortic rupture
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