Dissecting Thoracic Aneurysm

Aneurysm refers to a localized dilation or widening of an artery, especially in the abdominal aorta. Dilation occurs to an extent more than 50%. Dissecting thoracic aneurysm is a condition where a tear occurs on the thoracic aorta. This creates a passage for blood between the aortal layers and leads to a dangerous condition. A false channel is thus created for the arterial blood. Besides it may hamper the blood supply to tributary arteries.

When there is excessive dilation of the artery, an aortic aneurysm can rupture. Internal bleeding can result and can be life-threatening. Usually the symptoms begin to appear when the aneurysm has become fairly large. A person suffering from dissecting thoracic aneurysm experiences severe abdominal and back pain. The pain is high up on the back, between the shoulder blades. There is increased risk of stroke or heart attack. The voice becomes hoarse and there is difficulty in swallowing. Persons suffering from dissection may experience symptoms similar to paraplegia or stroke due to impaired blood supply to the spinal chord and limbs. Marfan's syndrome is a variant of this condition. Traumatic aneurysms are caused by injury to the chest or blunt chest trauma.

Diagnosis of dissecting thoracic aneurysm is done with a routine physical examination as well as chest and abdominal x-rays. MRI scan also helps in determining the precise location of the aneurysm. Transthoracic ultrasonography aids in accurate sizing of the aneurysm. Patients suffering from thoracic aneurysm condition are advised to avoid smoking and get regular medical check ups done. Blood pressure must be lowered with drugs to reduce the impact on the aortal tear. Surgical treatment for dissecting thoracic aneurysm involves replacing the affected part of the aorta with a synthetic graft.

Mantoux test

The Mantoux test or tuberculin sensitivity test is a diagnostic test for tuberculosis. This test, also known as Piquet Test is endorsed by the American Thoracic Society and Centers for Disease Control and Prevention (CDC). The other diagnostic tests for tuberculosis are Tine test and Heaf test. Since the Mantoux test makes use of purified protein derivatives (PPD), it is also referred to as PPD test. This tuberculosis test does not indicate how long the infection has been festering or if it is in the active stage. This tuberculosis test is prescribed for persons who have abnormal chest x-rays or symptoms such as weight loss and persistent cough for many months. A Mantoux test is not recommended for those suffering from any skin conditions or allergy. Women who are pregnant or breastfeeding must not be subjected to the Mantoux test.

This PPD test involves injecting a dose of TB antigens into the top layer of skin on the forearm. The dose includes 10 Tuberculin units (0.2 ml) as this exposes the person to enough bacteria to mount an immune reaction in the skin. A little bump (wheal) is noticed under the skin. This area is then observed for any reaction in then next 48 - 72 hours. Reactions such as fever or swollen lymph nodes in the armpit must be brought to the notice of health professionals immediately. The results of this test must be interpreted carefully. A positive result indicates tuberculosis. There may be cases of false positives or false negative results. The significance of the Mantoux test on those vaccinated with BCG is still controversial.

Paraplegia

Paraplegia is sensory or motor disorder in the lower extremities of the body. The impairment is due to damage caused as a result of congenital deformities or trauma and spinal injuries. The effects of paraplegia are predominantly seen in the thoracic, lumbar and sacral region. The damage caused as a result of paraplegia can lead to other issues such as monoplegia (dysfunction of one organ), paralysis and some times fecal incontinence and impotence.

Spastic paraplegia and flaccid paraplegia are two important forms of the disease which are differentiated based on the location. Flaccid paraplegia is associated with the lesion caused in the spinal cord; which in turn causes two significant forms of myelopathies compressive and non-compressive respectively. The compressive form of paraplegia occurs because of the destruction of the spinal cord due to pressure exerted on it. In most cases the pressures caused are because of underlying medical conditions such as neoplasms, degenerative spinal disease or hematoma. The compressive forms are predominantly located in extradural and subdural regions causing extra medullary and intramedullary complications such as neurofibroma and meningioma.

The lesions caused affect the spinal arteries causing ischemia eventually leading to tissue necrosis in the respective region. This leads to the development of edema in the spinal region causing compression and damage. Because of increased pressure, paraplegia can initiate complications such as pneumonia, pressure sores which are decubitus in origin. Often the pain associated with paraplegia radiates in the region of nerve damage. Vitamin B 12 deficiency also leads to the occurrence of paraplegia of non compressive origin.