Author: Irini Yanny / Editor: Sarah Edwards / Codes: NeuP9, RP8, SLO1, SLO3, VC1, VC3 / Published: 04/10/2024
A 29-year-old male presents to the emergency department (ED) with collapse and some chest pain which has resolved. On and off back pain. He has had a 5/7 history of light-headedness and unsteadiness.
He has a background of Crohn’s (no flare for 4/12), Rheumatoid Arthritis and HLA-B27 spondyloarthropathy, previous latent TB, asthma (well-controlled) and cholesteotomas with multiple revisions. He is on Infliximab.
You ask him what he was doing at the time and he tells you he was pulling pints behind the bar and felt fine prior.
On examination:
He is noted to have warm peripheries with a normal capillary refill but a pulseless left arm – With no brachial or radial pulse.
Blood pressure is 158/110 on the right arm; 119/80 left arm. The ECG is normal.
There is no evidence of tongue biting or incontinence. Lactate and Glucose are normal.
He tells you he has had episodes where he has felt dizzy before and perhaps this is more when he is working.
You consider an aortic dissection and order a CT angiogram (you do a DDimers for good measure and decide not to wait before scanning). To your surprise, this comes back as normal.