Question

A 58-year-old woman presents with a 3-month history of postprandial abdominal pain. This crampy pain occurs 30 minutes after eating, every time. Due to these symptoms, the patient has lost 30 pounds and is afraid to eat. Her past medical history includes hypertension treated with enalapril, coronary artery disease for which she has undergone a right coronary artery stent, and she underwent a carotid endarterectomy for symptomatic carotid stenosis. She has smoked 2 packs of cigarettes a day for 30 years.

What is the best initial test for this patient?

1 Mesenteric angiogram
2 Mesenteric duplex ultrasound
3 Computerized tomography (CT)
4 Magnetic resonance angiography (MRA)
5 Computerized tomography angiography (CTA)

Answer 1

The initial test recommended for the described patient's symptoms is a Mesenteric duplex ultrasound, which is a non-invasive method to evaluate blood flow and potential blockages in the mesenteric vessels which could indicate ischemia.

Step-by-step explanation:

The 58-year-old woman's symptoms of postprandial abdominal pain, significant weight loss, and her history of vascular issues suggest a possible case of mesenteric ischemia. Considering her medical background, including hypertension, coronary artery disease with previous stenting, and carotid endarterectomy, together with her smoking history, she is at risk for atherosclerotic disease, which could affect her mesenteric vessels.

The best initial test for this patient would likely be Mesenteric duplex ultrasound. This non-invasive test can assess blood flow in the mesenteric vessels and determine if there are any blockages or abnormalities indicating ischemia. More invasive tests like a mesenteric angiogram, CT angiography (CTA), or magnetic resonance angiography (MRA) could be employed later for further assessment based on the ultrasound findings.