Вальсальва

AOkhotin писал(а): ↑

Чт авг 16, 2018 5:50 pm

Do you monitor SpO2 during stress test?

There is possibility, but not as routine and not in this patient

Exactly,do you?Pawel?
In Norway is this standard,monitoring of saturation?
Now,I see your answer,ok,You did not expect something wrong

And finally CT in LE protocoll :

Cine loop

Cine loop 2.

Nice case, thank you. I think I wouldn't do D-dimer or legs ultrasound just because of mild exercise induced pulmonary hypertension in 75 y.o.
But it is always worth listening to patient, not saying "you are ok" if he says you "I am not ok".

William Osler" писал(а):Just listen to your patient, he is telling you the diagnosis.

Did you perform CT of pulmonary arteries?

Oops, I see you did.

Interestingly, right ventricle seems slightly enlarged on CT, but not on echo. May be it was enlarged in some other views?

If there is enlargement of right ventricle,rather in a shape of Athlet's heart than CTEPH,in my opinion

Wojtek Guzowski писал(а): ↑

Чт авг 16, 2018 8:00 pm

If there is enlargement of right ventricle,rather in a shape of Athlet's heart than CTEPH,in my opinion

In this plane it seems to me more like in PE. But single plane obviously is not enough and I am not a specialist in CT.

AOkhotin писал(а): ↑

Чт авг 16, 2018 8:59 pm

Wojtek Guzowski писал(а): ↑

Чт авг 16, 2018 8:00 pm

If there is enlargement of right ventricle,rather in a shape of Athlet's heart than CTEPH,in my opinion

In this plane it seems to me more like in PE. But single plane obviously is not enough and I am not a specialist in CT.

Maybe it is a little bit enlarged in CT, yes , but to be honest CT is not a good tool to validate ventricle enlargement if nott spectacular anlarged. I give you also CT of helthy patient from my collection that one can asses right ventricle enlargement. As a curiosity - from my collection I want to pressent you spectactacular ecco case of pulmonary embolism

and CT of this man:

Incredible,total attack

Impressive images. Had you performed thrombolysis?

Не совсем логичный путь к диагнозу. Невизуализирующий стресс-тест в 72 года с одышкой при физ. нагрузке?! Интересно, что явилось причиной DVT? Вторичная тромбофилия? Онкопатологии не выявлено?

P.S. Артемий! Какой бы диагностический алгоритм выбрали Вы у данного пациента?