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April 2020

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From:
"Schwend, Ray" <[log in to unmask]>
Reply To:
UVM Flownet <[log in to unmask]>
Date:
Wed, 29 Apr 2020 16:28:37 +0000
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Your ECA looks like it has a prolonged acceleration time, suggesting a significant proximal involvement.
I take it was accessed extra-cranially? Did you check the ICA and most importantly CCA?
As this a unilateral evaluation? If not- How did it compare side to side?

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Andrew Bachman
Sent: Wednesday, April 29, 2020 9:22 AM
To: [log in to unmask]
Subject: [External] 1st in my career today. Ran out of ideas

WARNING! External email.  Handle links and/or attachments with caution.  IS Service Desk @ 858-678-7500

I have done close to 500 temporal artery studies in my career and today was a first.....

Patient presents with intermittent vision loss and occasional jaw pain when eating.  Her ESR was mildly elevated at 35mm/hour and has occasional headaches.  All makes sense; however, here is when it became fun!!!!

ECA and early segments of the Common STA are essentially normal with antegrade flow and maybe a higher diastolic flow then normal but nothing crazy.  The Middle STA and both Parietal and Frontal ramus branches exhibit OSCILLATING flow with a retrograde Systolic component and an antegrade diastolic pull.  

She was a VERY hard study and the distal Common STA was not visualized.  My 1st thought was for some reason the Internal Maxillary was Stealing the blood; however to add another curveball, the flow in the Middle STA becomes more antegrade when I had patient exercise her jaw.

I am stumped!!!  Any thoughts?
Andrew M. Bachman, Bs RVT
Technical Director / Vascular Lab Clinical Specialist St. Lukes University Hospital and Health Network [log in to unmask]
PH: 610-704-2821
 
"To handle yourself, use your head. To handle others, use your heart"


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