A 69-year-old with eGFR 24 mL/min/1.73 m² develops abrupt tearing chest pain, pulse asymmetry and shock. CT angiography is immediately available and

Question

A 69-year-old with eGFR 24 mL/min/1.73 m² develops abrupt tearing chest pain, pulse asymmetry and shock. CT angiography is immediately available and the aortic team is alerted. What should happen?

Accepted Answer

Proceed with contrast CT angiography while applying renal-risk mitigation measures

Answer

Obtain serial creatinine measurements before proceeding to contrast CT angiography

Answer

Commence haemodialysis before contrast CT to reduce the renal iodine burden

Answer

Use non-contrast CT initially because eGFR is below 30 mL/min/1.73 m²

Answer

Use transoesophageal echocardiography first and reserve CT for equivocal findings

Pulmonary AVM Clubbing — RACP Adult Medicine MCQ

A 69-year-old with eGFR 24 mL/min/1.73 m² develops abrupt tearing chest pain, pulse asymmetry and shock. CT angiography is immediately available and the aortic team is alerted. What should happen?