Anyone know the answer?

[Thursday]

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There's no answer to this question on my version of the Pestana vignettes for surg shelf:
.– A patient involved in a high speed automobile collision has multiple injuries, including rib fractures and abdominal contusions. Insertion of a Foley catheter shows that there is hematuria, and retrograde cystogram is normal. CT scan shows renal injuries that do not require surgery. Six weeks later the patient develops acute shortness of breath and a flank bruit..

What is it and how do we manage it?

 

[Scaredshizzles]

There's no answer to this question on my version of the Pestana vignettes for surg shelf:
.– A patient involved in a high speed automobile collision has multiple injuries, including rib fractures and abdominal contusions. Insertion of a Foley catheter shows that there is hematuria, and retrograde cystogram is normal. CT scan shows renal injuries that do not require surgery. Six weeks later the patient develops acute shortness of breath and a flank bruit..

What is it and how do we manage it?

The renal artery and vein have anastomosed after the vessal walls were disrupted by the trauma....(They likewise can ask about development of a femoral bruit and high output HF 2-3 weeks after groin trauma...)...The management is surgical...I think the exact type of surgery might be debatable....And I can't really tell you what imaging would be appropriate either, but I doubt they would ask anyone that until the surgical boards at the end of a 5 year residency.

 

[tfom08]

The renal artery and vein have anastomosed after the vessal walls were disrupted by the trauma....(They likewise can ask about development of a femoral bruit and high output HF 2-3 weeks after groin trauma...)...The management is surgical...I think the exact type of surgery might be debatable....And I can't really tell you what imaging would be appropriate either, but I doubt they would ask anyone that until the surgical boards at the end of a 5 year residency.

+1. I feel like on my surgery shelf this question showed up more than once in different anatomic locations. Anytime there is injury and then a bruit forms followed by heart failure, it's a fistula. I think there was an aortoenteric fistula on my shelf as well. I'm not positive, but I think Pestana has this vignette but his example is a stab wound that heals and leads to a fistula.

 

[Scaredshizzles]

+1. I feel like on my surgery shelf this question showed up more than once in different anatomic locations. Anytime there is injury and then a bruit forms followed by heart failure, it's a fistula. I think there was an aortoenteric fistula on my shelf as well. I'm not positive, but I think Pestana has this vignette but his example is a stab wound that heals and leads to a fistula.

Yes, I believe you're correct, fistula is the term they usually use, not anastomosis. I imagine they are doing endovascular procedures these days for this sort of thing, not that it could be overly common.

 

[sarahthetran]

haha. i KNEW someone here would have that answer.
thanks y'all.