A Special Case
In this installment I would like to go back over one interesting finding from the past. In the 1970's I was working in an interventional department, of course we called it "Special Procedures" at the time, of a rather large hospital. The cardiologist also used the suite to do cardiac studies. Techniques and equipment were rather primitive, if you compared it to departments of today.
One day a young female, age around sixteen came in to the ER after a minor injury in a scholastic sporting event. The first evaluation was to get vital signs. The nursing staff became alarmed because they could not locate a pulse or get a blood pressure reading.However the young lady appeared just fine.
Since it was so long ago, echocardiography ,ultrasound, and CT were non existent. It seems hard to think how physicians made any diagnosis without them. Eventually the patient was seen by a cardiologist, I do not know or remember how all the steps came about, but talk of this case circuited in the department. I remember the doctor talking about this special case that was very rare only a few of them were diagnosed and most of the similar cases were found on autopsy.
The diagnosis was Coarctation of the Aorta with and aberrant subclavian artery. The question was how to film it. It was decided to place a catheter in the pulmonary artery and inject there as if we were doing a pulmonary angiogram. Manual subtracted films of the area provided the visual proof. The patient was referred to Baylor University for surgery .I did find out later that the young lady did well with the surgery and resumed a normal life.
Reading some of the literature on like cases there are reported cases with differences in where the sub avian artery originates either preductal,ductal or postductal. Unfortunately I do not remember which category that this fell into. Thank science for advances in both techniques and more sophisticated diagnostic equipment.