How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Daniel Nelson, MD Your Own Question

Daniel Nelson, MD
Daniel Nelson, MD, Doctor (MD)
Category: Health
Satisfied Customers: 258
Experience:  Licensed MD. Mayo Clinic Rochester trained physician in Internal Medicine - Critical Care Medicine.
8322836
Type Your Health Question Here...
Daniel Nelson, MD is online now
A new question is answered every 9 seconds

On a CT scan it read -atherosclerotic changes to the

Customer Question

On a CT scan it read -atherosclerotic changes to the aorta. Is this serious?
Submitted: 6 years ago.
Category: Health
Expert:  Daniel Nelson, MD replied 6 years ago.

DearCustomer If you have the full CT report, it would be most helpful. That being said, we can begin to see atherosclerotic changes on CT in some people as early as age 10!

Atherosclerotic changes can be serious. It will depend on the extent, size, and degree of calcification present within the plaques. This is where the actual report comes in handy.

In order to better address your concerns and question, I need to ask you a few additional questions:

  • What is your gender and age?
  • Why was the CT performed?
  • Do you have any heart attack or stroke risk factors?
    (like smoking, obesity, high blood pressure, high LDL or low HDL, elevated C-reactive protein, diabetes, first degree male blood relative with a heart attack at age 55 or younger, or first degree female blood relative with a heart attack at age 65 or younger, sedentary lifestyle, etc.)
  • Do you have the full CT report? If so, can you type it into this discussion?

Once I hear back from you, I will respond.

Kindest Regards,
XXXXX XXXXX, MD

Expert:  Daniel Nelson, MD replied 6 years ago.

It looks like you went offline, so I will go ahead and provide some additional information about Aortic Atherosclerosis. Atherosclerosis is serious no matter how we look at it. It carries with it risks of rupturing or breakage that can cause pieces of it, or a resulting clot at the site of plaque rupture, to shed off and flow to various parts of the body -- including heart, arms, brain, kidneys, legs, and many other locations. This can result in blockage of blood flow to that particular part of the body. If the particle of plaque or clot flows to the brain, it can cause a stroke ... to the coronary arteries, it can cause a heart attack.

Here is a video prepared by my alma mater at the Mayo Clinic in Rochester:

Here are some resources on the atherosclerosis process, itself:

Now, just how serious your aortic atherosclerosis changes are depends a lot upon your risk factors, as noted above. Also, the process of plaque instability comes into play, and it appears that inflammatory processes and even infections play a role in destabilising plaques of atherosclerosis, increasing their risk of rupture or breakage.

You should discuss with your physician or Cardiovascular Diseases specialist exactly how you can minimise the risk of developing progression of these atherosclerotic changes, and how to best stabilise them to keep them from rupturing. It appears that the drugs called "statins" play a crucial role in plaque stabilisation even if they don't lower cholesterol as much as we sometimes hope. Statin medications work on at least 20 different steps in the cholesterol synthesis and transport pathways, and we are only touching the tip of the iceberg in realising their benefits.

Thank you for visiting JustAnswer.com's Health Information. I hope that all of your concerns have been addressed and that your experience here was positive and helpful. If you have a new or different question, please don't hesitate to come back or submit a new question. It has been a pleasure helping you. Your FEEDBACK is very important to me.

Kindest Regards,
XXXXX XXXXX, MD

Customer: replied 6 years ago.
Reply to XXXXX XXXXX, MD's Post: I had the Ct because of pain in the area under the
shoulder blade. Its always there, not a bad pain just constant. It was waking me during the night.It was worse at night.
Twice it has been severe,but it came around the front under my rib area.I was sick to my stomach and sweating.
When I seen my Dr. he checked my urine, which had hematuria. I'm female @47. I had a severe surgery
in 2002, which left my stomach half in the chest area. But, my blood pressure is fine. 115/75.I work out 3 times a week. I have issues with dizziness when laying down and sitting up. Hope tis helps.
Expert:  Daniel Nelson, MD replied 6 years ago.

Thank you very much for the additional information. It is helpful and appreciated. I apologise for my delay in responding today, I just got off work very late but wanted to check on any responses here at JustAnswer.com before retiring.

The discomfort under the shoulder blade does not sound typical of cardiac pain, although I am glad they did a CT of the chest because constant pain like that does worry me for aortic problems. I wonder if the CT images reached down to the level of the kidneys at all? The hematuria is difficult to assess over the discussion here, because it requires all the technical terminology, other labs, imaging, and physical examination findings in order to diagnose ... sometimes even more invasive studies such as ultrasound or CT guided biopsy are needed.

The other pain, the one that radiated around and under the rib area, also sounds atypical for cardiac pain, but again is very hard to discern through discussion here. Cardiac pain in women is sometimes very atypical, and causes many physicians to write it off as something else. Although you work out three times weekly, it would be reasonable to have a stress test evaluation to evaluate your exertional tolerance and stress EKG. The same process that causes atherosclerosis in the aorta takes place in the coronary arteries, cerebral arteries, and other major arteries throughout the body.

Some questions to address with your physician:

Could it be pain from chest or abdominal adhesions following your surgery (possible)? Could it be related to the hematuria (quite possible, kidney stones?)? If it was right-sided, could it be gallbladder or gallstones (possible, plus this pain often radiates to the back and/or shoulder ridges)? Did your physician do liver function labs? Did your labs include tests for inflammation of the pancreas (which can radiate toward the back and between the shoulder blades)?

These are just some of the immediate thoughts going through my mind as I read your additional information in the context of your initial information. There is a lot of ground to cover here. I would prioritise things as such to evaluate the hematuria promptly and to make sure your heart is healthy and able to well-withstand a stress EKG study. Along the same timeline, I belive that the other issues raised in the questions above could be evaluated if they have not already been completed.

  • Evaluate the hematuria - more tests
  • Evaluate your heart under stress - Treadmill stress EKG
  • Discuss the role of medications like statins for atherosclerotic plaque stabilisation (and cholesterol regulation) depending on the exact findings of the CT scan, treadmill stress test, and blood lipids.
  • Evaluate the pain under the front rib area ... related to hematuria, gallstones, liver problems, pancreas, adhesions, etc.?

That would be my work-flow in your scenario. Most of this is just me typing out loud, but I do want you to be aware of what crosses my mind as I think about all of these issues. I am a little overprotective of all of you, my little flock of Internet information seekers, but I am proud of you for having excellent insight and seeking information in order to be an informed patient. While I am not privy to all the information that your physician is, this information may help you to ask the right questions and to address your concerns clearly and concisely to your doc.

In the end, all I hope for is that I have helped you in some way, shape, or form. I wish you well. I would greatly appreciate updates and progress notes on how you are doing and what you are finding out. You can pop in here and drop me a note any time. I am at your service!

Regards,
XXXXX XXXXX, MD

Expert:  Daniel Nelson, MD replied 6 years ago.

Do you have any other questions or concerns? If not, please click the ACCEPT button so that I may get credit for my work. If you have any questions or concerns along this line, we can still continue to discuss things even once you click ACCEPT. I hope the information I provided was useful. I do wish you well, and appreciate your allowing me the opportunity to provide this information.

Kindest Regards,
Daniel

--
XXXXX XXXXX, MD

Customer: replied 6 years ago.
Reply to XXXXX XXXXX, MD's Post: The CT scan was with and without contrast and showed the kidney's ,pancreas,gallbladder,liver.
It was all ok. I do have scar tissue on the left kidney proir surgery was cause. The pelvic area was also done and everything was ok. I thank you for your input. I will except as soon as Wed. Have to pay on my card, (sorry for the delay) I woke up quite a bit last night from the pain, I think I will take my ct scans to the Dr. that performed the thorasic surgery in 2002. He may have some answers too. Again, thank you. I will let you know if anything comes of the visit.
Expert:  Daniel Nelson, MD replied 6 years ago.

I am relieved to hear that the CT imaging was continued on down through the abdomen and pelvis. The haematuria (hematuria) remains concerning, and I hope that the physician(s) is/are paying due attention to that issue. If there are red cell casts (packed together instead of just free floating), white cell casts, or hyaline casts the cause of the haematuria is coming from the kidney level glomeruli or tubular level. If there are no red cell casts, then the workup will focus on other causes at lower levels than the kidney tubules.

Adhesions remain a possible cause of the pain, and if you were my patient I would feel obligated to make sure your coronary arteries are capable of keeping up with stress demands during exertion, since the atherosclerotic process isn't particular about which arteries it affects ... it tends to be a ubiquitous, wide-spread process. The specific terminology of the CT report on the plaque changes is important, such as size, extent, locations, calcification, and aortic diametre. I would discuss the pro's and con's of considering a plaque stabilising medication from the "statin" class of medications because of their pleiotropic (having many effects, not just "lowering cholesterol") effects.

I do appreciate progress updates, but you don't have to feel obligated to do so ... and, I welcome follow-up questions or concerns should they arise along this same topic. I am at your service. Be well. /Daniel

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
< Last | Next >
  • http://ww2.justanswer.com/uploads/NU/nursescare4u/2013-3-31_03429_JApic.64x64.jpg Nurse Milli, RN's Avatar

    Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Doctor

    Satisfied Customers:

    102
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    5622
    Emergency Medicine and Family Practice for over 26 years
  • http://ww2.justanswer.com/uploads/drphophalia/2007-08-23_095626_dr._arun_phophalia.jpg Dr. Arun Phophalia's Avatar

    Dr. Arun Phophalia

    Doctor (MD)

    Satisfied Customers:

    17025
    MBBS, MS (General Surgery), Fellowship in Sports Medicine
  • http://ww2.justanswer.com/uploads/VA/VANP/2012-6-6_235535_Skye2.64x64.jpg A. Schuyler, NP's Avatar

    A. Schuyler, NP

    Nurse Practitioner

    Satisfied Customers:

    12170
    Board Certified NP, MS, RN. Private practice & hospitalist
  • http://ww2.justanswer.com/uploads/TA/tazechip/2012-6-7_135230_drpic.64x64.png Dr. Chip's Avatar

    Dr. Chip

    Doctor (MD)

    Satisfied Customers:

    10029
    Over 20 yrs of Family Practice
  • http://ww2.justanswer.com/uploads/neurosurg/2009-10-06_120923_profile.jpg Dr. Mark's Avatar

    Dr. Mark

    Doctor (MD)

    Satisfied Customers:

    6234
    U.S. Physician/Surgeon in Neurosurgery