This gentleman was really, really nice, but he should have been dead before he even got to our hospital. I wouldn’t be surprised if this was close to a reportable case due to the size of it.
He’d had multiple kidney stones in the past and came in complaining of a “Kidney Stone”. Classic pain, left flank radiating to his left groin. You know, his pain may have actually been caused by the kidney stone, but that’s not why he should have been dead.
Whenever i have a patient with a history of kidney stones, I always review previous CT scans to see how recently one was done, how large the stones were and if there were any in waiting in the kidneys. Despite being seen by one of our urologists, this guy had no previous CT scans at our hospital.
Which means that this thing that almost killed him must have grown fast!
We gave him narcotics, narcotics and more narcotics and he was still having 10/10 pain. Must be a really big kidney stone I continued to think. Erroniously.
Finally, 4 hours after arrival, our “routine” CT scan is performed (don’t worry, an ultrasound would not have been any faster). I listed to the radiologists report in one ear while listening to a nurse in the other ear and writing on a 3rd patient’s chart.
Then I just about dropped everything and asked the radiologist to repeat what he had said…
“The patient has an 8 centimeter leaking aortic aneurism. Do you have a vascular surgeon there?”
My heart started to race, but I had to keep my cool for the patient’s sake. Ruptured aortic aneurisms are fatal, plain and simple. This man should have been dead. 50% of ruptured aneurisms don’t make it to the hospital at all. How long had his been leaking? How long had his been growing?
I looked at the CT scan. It was probably the biggest aneurism I’ve ever seen. AND IT WAS LEAKING!
The vascular surgeon came down and personally wheeled the patient up to the OR, where a graft was successfully placed, and he was extubated in the ICU later that night.
Another life saved on Doc Shazam’s watch.
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