Thoracic aorta mildly tortuous - Tortuosity may affect virtually any arterial bed, from small size vessels, such as subungual capillaries and retinal arteries to middle and large size arteries, such as the coronary, cerebrovascular or iliac vessels, as well …

 
Q25.46. ICD-10 code Q25.46 for Tortuous aortic arch is a medical classification as listed by WHO under the range - Congenital malformations, deformations and chromosomal abnormalities .. Alfredo aiello italian foods inc

Aortic Ectasia is common as we age, and commonly an incidental finding on chest X-Ray. It usually does not require further testing. Good control of BP if the patient has hypertension is important as Aortic Ectasia is seen more in hypertensive people.An isolated aortic arch aneurysm is an uncommon disease entity and often remains clinically silent, given its indolent growth pattern. Aneurysms of the aortic arch are commonly found in association with aneurysms of the adjacent ascending or descending aorta. The true incidence and natural course are still relatively unknown; however, …Dilated aortic root. Ectasia of thoracic aorta. ICD-10-CM I77.810 is grouped within Diagnostic Related Group (s) (MS-DRG v41.0): 299 Peripheral vascular disorders with mcc. 300 Peripheral vascular disorders with cc. 301 Peripheral vascular disorders without cc/mcc. Convert I77.810 to ICD-9-CM.Sep 9, 2019 · Tortuous arteries and veins are commonly observed in humans and animals. While mild tortuosity is asymptomatic, severe tortuosity can lead to ischemic attack in distal organs. Clinical observations have linked tortuous arteries and veins with aging, atherosclerosis, hypertension, genetic defects and diabetes mellitus. Introduction: Tortuosity in the descending thoracic aorta is becoming more important since thoracic endovascular aortic repair (TEVAR) is the gold standard for treating thoracic aortic disease. The literature reports that tortuosity has an influence on the occurrence of endoleaks1. There is some literature defining the angulation and …Your descending aorta refers to the part of your aorta that extends downward from your aortic arch. It travels through your chest (descending thoracic aorta) and your belly (descending abdominal aorta). So, your thoracic aorta and your descending aorta aren’t the same. But your thoracic aorta includes part of your descending aorta.The biggest artery is the aorta, running from your chest to your abdomen. If fats, cholesterol, and other substances begin building up inside your arteries, that causes hard lesions, called plaque ...Thoracic Endovascular Aortic Repair (TEVAR) is performed by placing a covered stent graft into the descending thoracic aorta via transfemoral access. The stent graft prevents blood flow from entering the aneurysm sac, resulting in aneurysm sac thrombosis and stabilization and/or regression. Printer-Friendly Version. Interactive 5.Similarly, the descending thoracic aorta is contralateral to the side of dominant arch. The two aortic arches can be of the same caliber, or else one of the arches may be atretic or hypoplastic. ... It takes a tortuous course, always lies in extra pericardial sac, and terminates in either the dorsal aorta or the pulmonary artery via the ductus ...Dec 30, 2013 · Dysphagia aortica is a difficulty in swallowing caused by extrinsic compression of the esophagus due to an ectatic, tortuous, or aneurysmatic atherosclerotic thoracic aorta. This condition is very uncommon, and it is usually associated with old age, women with short stature, hypertension, and kyphosis. What You Need to Know. Most patients with thoracic aortic aneurysms do not have any symptoms; they are usually diagnosed on imaging studies performed for another reason. … Abstract. Thoracic aortic calcification (TAC) is associated with adverse cardiovascular outcomes, and for the cardiovascular imager, is predominantly encountered in 4 settings: 1) incidentally, for example, during a coronary artery calcium scan; 2) as part of dedicated screening; 3) in the evaluation of an embolic event; or 4) in procedural ... Abstract. Thoracic aortic calcification (TAC) is associated with adverse cardiovascular outcomes, and for the cardiovascular imager, is predominantly encountered in 4 settings: 1) incidentally, for example, during a coronary artery calcium scan; 2) as part of dedicated screening; 3) in the evaluation of an embolic event; or 4) in procedural ... What You Need to Know. Most patients with thoracic aortic aneurysms do not have any symptoms; they are usually diagnosed on imaging studies performed for another reason. … Thoracic aortic aneurysm (TAA) is a commonly encountered disease that is defined as aortic dilation with an increase in diameter of at least 50% greater than the expected age- and sex-adjusted size. Thoracic aortic aneurysms are described by their size, location, morphology, and cause. Primary care clinicians and other noncardiologists are often the first point of contact for patients with TAA ... The upward part of the arch, which is the section closest to the heart, is called the ascending aorta. The part of the aorta in the chest is called the thoracic aorta. Can a tortuous aorta be fixed? While many mild tortuous arteries are left untreated, severely tortuous arteries with clinical symptoms can be treated with reconstructive surgery ...If an aneurysm forms between the upper and lower parts of the aorta, it's called a thoracoabdominal aneurysm. A thoracic aneurysm may be round or tube-shaped. Aneurysms can occur anywhere in the thoracic aorta, including near the heart, in the aortic arch and in the lower part of the thoracic aorta. Causes of thoracic aortic aneurysms …A computed tomography (CT) scan of the thoracic spine is an imaging method. This uses x-rays to rapidly create detailed pictures of the middle back (thoracic spine). A computed tom...Arterial tortuosity syndrome (ATS) is a rare, autosomal recessively inherited connective tissue disorder characterized by severe and widespread tortuosity of the aorta and of middle-sized arteries with an increased risk of aneurysm, dissection, or stenosis involving the aorta, the pulmonary arteries, or both.Oct 14, 2021 · An ascending aortic aneurysm is a bulging area in the first part of the aorta, the main artery in your body. An aneurysm is a weak spot in a blood vessel wall. Aneurysms can tear or rupture (break open) and cause severe, life-threatening internal bleeding. These aneurysms are also called ascending thoracic aortic aneurysms (ATAAs) since they ... Several heart disorders can lead to mild cardiomegaly: High blood pressure: High blood pressure (hypertension) is the most frequent cause of an enlarged heart. High blood pressure makes it …Case. An 87-year-old woman with atrial fibrillation, a history of deep venous thrombosis, and a long smoking history was admitted with progressive shortness of breath and productive cough of 2 days’ duration with subjective fevers and chills. Vital signs on admission included a respiratory rate of 30 breaths/min and oxygen saturation of 89% ...The thoracic aorta is a part of the aorta located in the thorax.It is a continuation of the aortic arch.It is located within the posterior mediastinal cavity, but frequently bulges into the left pleural cavity.The descending thoracic aorta begins at the lower border of the fourth thoracic vertebra and ends in front of the lower border of the twelfth thoracic vertebra, … This is a tear between the inner and outer layers of the aorta wall. The tear can cause the wall to separate and burst. This can cause serious bleeding. Limb ischemia (say "iss-KEE-mee-yuh"). This means that your limb, usually a leg, is not getting enough oxygen. It happens when a blood clot moves from the aorta to an artery in a leg. The proximal descending thoracic aorta was extremely tortuous and accompanied by a local narrowing, a pseudo-coarctation at the level of the ligamentum arteriosum. No additional aneurysms were detected within the CTA. The patient was immediately transferred to our aortic expertise center for emergency repair.The part of the aorta in the chest is called the thoracic aorta. Can a tortuous aorta be fixed? While many mild tortuous arteries are left untreated, severely tortuous arteries with clinical symptoms can be treated with reconstructive surgery [61]. Severely tortuous or kinking carotid arteries have often been treated by surgical shortening ...Antidepressant and vitamins have no role in aortic dilatation. Following up with your cardiologist regularly for the aortic dilatation is important. Find a Doctor Make an Appointment. One should monitor the size of your aortic root and ascending aorta in serial MRA/CTA studies. You also need to continue modifying your risk factors as you are doing.An isolated aortic arch aneurysm is an uncommon disease entity and often remains clinically silent, given its indolent growth pattern. Aneurysms of the aortic arch are commonly found in association with aneurysms of the adjacent ascending or descending aorta. The true incidence and natural course are still relatively unknown; however, …Dilated aortic root. Ectasia of thoracic aorta. ICD-10-CM I77.810 is grouped within Diagnostic Related Group (s) (MS-DRG v41.0): 299 Peripheral vascular disorders with mcc. 300 Peripheral vascular disorders with cc. 301 Peripheral vascular disorders without cc/mcc. Convert I77.810 to ICD-9-CM.Tortuosity may affect virtually any arterial bed, from small size vessels, such as subungual capillaries and retinal arteries to middle and large size arteries, such as the coronary, cerebrovascular or iliac vessels, as well …The 2024 edition of ICD-10-CM I71.2 became effective on October 1, 2023. This is the American ICD-10-CM version of I71.2 - other international versions of ICD-10 I71.2 may differ. Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes. ICD 10 code for Thoracic aortic aneurysm, without rupture.Dilation of the ascending aorta entails a high risk of dissection or aortic rupture in the absence of surgical treatment. Overall, it represents 50% of all thoracic aneurysms, but can be separated into two distinct entities, according to aetiology and surgical management: (1) the aortic root aneurysm, concerning the initial portion, the so called “aortic root”, that includes the sinuses of ...We would like to show you a description here but the site won’t allow us. Thoracic aortic aneurysm (TAA) is a commonly encountered disease that is defined as aortic dilation with an increase in diameter of at least 50% greater than the expected age- and sex-adjusted size. Thoracic aortic aneurysms are described by their size, location, morphology, and cause. Primary care clinicians and other noncardiologists are often the first point of contact for patients with TAA ... Tortuosity may affect virtually any arterial bed, from small size vessels, such as subungual capillaries and retinal arteries to middle and large size arteries, such as the coronary, cerebrovascular or iliac vessels, as well …Specialities include: Family Medicine, Internal Medicine, Urgent Care, Radiology, Pathology, Anesthesiology. Doctor: Dr. Mark. Hi, this is common and not serious. It's not an aneurysm of the aorta. It means that the aorta is mildly twisted, and this is very common as we get older. Nothing needs to be done about it as it's a common finding on a ...An aneurysm may occur because of a localized weakness of the artery wall (saccular). Enlargement of the aorta may be only mild in degree (ectasia). When a weak area of your thoracic aorta expands or bulges, it is called a thoracic aortic aneurysm (TAA). Approximately 25 percent of aortic aneurysms occur in the chest and the rest occur in …3rd xray showed no pneumothorax. but indicated thoracic aorta mildly tortuous. Can exercise help, if so what kind. Thank you Helpful - 0. Comment. kenkeith. I'm not familiar with Life Line Screening, but abdominal aneurysm is a bulge of the aorta (large vessel from the heart that supplies blood to system). Normally, the aorta is about one inch ... I77.819 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2024 edition of ICD-10-CM I77.819 became effective on October 1, 2023. This is the American ICD-10-CM version of I77.819 - other international versions of ICD-10 I77.819 may differ. Thoracic aorta. The thoracic aorta begins where the left ventricle ends at the aortic valve and continues down through the chest. A weakening of the artery wall in this region is called a thoracic aortic aneurysm. A healthy aorta is about 1 inch (2.5 centimeters [cm]) wide, or about the diameter of a garden hose.This decision has been informed by both our internal discussions and the Society for Vascular Surgery guidelines (Table). 13 Surgery for most patients with isolated descending thoracic or abdominal aortic aneurysms <6.5 cm and patients with root, ascending, or arch aneurysms <6.0 cm has been postponed until the surge has passed, …Aortic valve sclerosis — thickening and stiffness of the valve and mild aortic calcification — usually doesn't cause significant heart problems. But it requires regular checkups to make sure the condition isn't worsening. If the valve becomes severely narrowed (stenotic), aortic valve replacement surgery may be necessary. Thoracic aortic aneurysm (TAA) is a commonly encountered disease that is defined as aortic dilation with an increase in diameter of at least 50% greater than the expected age- and sex-adjusted size. Thoracic aortic aneurysms are described by their size, location, morphology, and cause. Primary care clinicians and other noncardiologists are often the first point of contact for patients with TAA ... A thoracic aortic aneurysm occurs along the part of the aorta that passes through the chest cavity. Some people may have both types of aortic aneurysms. Having …Multidetector cardiac computed tomography revealed markedly ectatic ascending aorta and arch and descending aorta with extreme tortuosity of all the arch branches and the abdominal aorta. A small segment of the proximal descending thoracic aorta was narrow. (Figures 2, 3A, and 3 B).Thoracic aortic aneurysm. A thoracic aortic aneurysm occurs along the part of the aorta that passes through the chest cavity. Some people may have both types of aortic aneurysms. Having an aortic aneurysm increases the risk of developing a tear in the inner layer of the wall of the aorta. This tear is called an aortic dissection.Morphometric measurements, including measurements of segmental length and tortuosity, were performed on three-dimensional models of the thoracic aorta. Results The length of the thoracic aorta was significantly related to age (r=0.54) and increased by 59 mm (males) or 66 mm (females) between the ages of 20 and 80 years. Elongation was most ...Case. An 87-year-old woman with atrial fibrillation, a history of deep venous thrombosis, and a long smoking history was admitted with progressive shortness of breath and productive cough of 2 days’ duration with subjective fevers and chills. Vital signs on admission included a respiratory rate of 30 breaths/min and oxygen saturation of 89% ...Tortuous aortic arch. Q25.46 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2024 edition of ICD-10-CM Q25.46 became effective on October 1, 2023. This is the American ICD-10-CM version of Q25.46 - other international versions of ICD-10 Q25.46 may differ.Specialities include: Family Medicine, Internal Medicine, Urgent Care, Radiology, Pathology, Anesthesiology. Doctor: Dr. Mark. Hi, this is common and not serious. It's not an aneurysm of the aorta. It means that the aorta is mildly twisted, and this is very common as we get older. Nothing needs to be done about it as it's a common finding on a ...Aortic unfolding is an abnormality visible on a chest X-ray, that shows widening of the mediastinum which may mimic the appearance of a thoracic aortic ... A tortuous aorta may be characterized as a twisted, curved, enlarged or narrowed blood vessel of the heart. An underlying cause of the distorted shape may be due to a build up of fatty tissue that collects on the walls of the vessels or, it may be a finding from birth. All patients had sliding hiatal hernias; these hiatal hernias, and the esophagitis and disordered motility seen in our patients, could be a consequence of esophageal displacement by the tortuous aorta. Two patients were relieved symptomatically with antacids and metoclopramide. Thus, tortuosity of the thoracic aorta can cause …The ascending thoracic aorta is mildly ectatic 3.7cm in diameter. the remaining visualized thoracic aorta is within normal limits. is there any problem? 2 doctors weighed in across 2 answers. ... What is "tortuous thoracic aorta and is it serious? A doctor has provided 1 answer. A member asked:Morphometric measurements, including measurements of segmental length and tortuosity, were performed on three-dimensional models of the thoracic aorta. Results The length of the thoracic aorta was significantly related to age (r=0.54) and increased by 59 mm (males) or 66 mm (females) between the ages of 20 and 80 years. Elongation was most ...The management of thoracic aortic aneurysm is reviewed here. The etiology, natural history, clinical features, and diagnosis of TAA, as well as specific techniques for repair of the thoracic aorta, are discussed separately. (See "Epidemiology, risk factors, pathogenesis, and natural history of thoracic aortic aneurysm and dissection" and ...Several heart disorders can lead to mild cardiomegaly: High blood pressure: High blood pressure (hypertension) is the most frequent cause of an enlarged heart. High blood pressure makes it …Furthermore, the aortic branches exhibited increased tortuosity with advancing age. These findings collectively suggest that age-related alterations in vessel structure contribute to arterial tortuosity, particularly in the thoracic aorta and its branches. Gender has been identified as a potential factor influencing arterial tortuosity.The part of the aorta in the chest is called the thoracic aorta. Can a tortuous aorta be fixed? While many mild tortuous arteries are left untreated, severely tortuous arteries with clinical symptoms can be treated with reconstructive surgery [61]. Severely tortuous or kinking carotid arteries have often been treated by surgical shortening ...Tortuosity of the thoracic aorta on chest radiographs is characteristic of atherosclerotic disease. Aging and hypertension are associated with the tortuosity, but little is known about the influence of other atherosclerotic risk factors on this abnormality. The purpose of this study was to examine w …Mild dilation of the aorta is not uncommon, but the risk of complications rises steeply as the aneurysm enlarges further. Small aneurysms are usually ... Abstract. Thoracic aortic calcification (TAC) is associated with adverse cardiovascular outcomes, and for the cardiovascular imager, is predominantly encountered in 4 settings: 1) incidentally, for example, during a coronary artery calcium scan; 2) as part of dedicated screening; 3) in the evaluation of an embolic event; or 4) in procedural ... A tortuous aorta (meaning excessively twisted and turned) is often seen in older people. Although this is a sign of aging, it may not mean that it is causing or will cause any problems. However it can indicate an increased risk for other aortic diseases, such as aortic aneurysm. What is mild tortuosity thoracic aorta?Objective Tortuosity in the descending thoracic aorta (DTA) comes with aging and increases the risk of endoleaks after TEVAR. With this report, we would like to define and classify tortuosity in the DTA of patients with thoracic aortic disease. Methods Retrospective case–control study of two hundred seven patients, comparing sixty-nine controls without aortic disease (CG), to sixty-nine ...Arterial tortuosity syndrome (ATS) is characterized by widespread elongation and tortuosity of the aorta and mid-sized arteries as well as focal stenosis of segments of the pulmonary arteries and/or aorta combined with findings of a generalized connective tissue disorder, which may include soft or doughy hyperextensible skin, joint …Thoracic Aortic Aneurysm and Aortic Dissection: A thoracic aortic aneurysm is a bulging, weakened area in the wall of the aorta resulting in an abnormal ...Aortic unfolding. ‘Unfolding’ of the aorta – a common X-ray finding in elderly patients – is a phenomenon which arises due to elongation of the ascending aorta with age. It is not usually considered a pathological finding in itself and should not be mistaken for an aortic aneurysm. It is often associated with calcification of the aorta ...Aortic atherosclerosis correlates with disease burden in other major arteries such as coronaries and carotids, with several histologic similarities. Autopsy studies have shown similar atherosclerotic plaque burden across arterial beds in a single patient. 1 In the aorta, there tends to be increasing atherosclerosis distally, with the formation ...Your descending aorta refers to the part of your aorta that extends downward from your aortic arch. It travels through your chest (descending thoracic aorta) and your belly (descending abdominal aorta). So, your thoracic aorta and your descending aorta aren’t the same. But your thoracic aorta includes part of your descending aorta.Anatomy of the thoracic aorta — The aorta is the major arterial conduit conveying blood from the heart to the systemic circulation. It originates immediately beyond the aortic valve and ascends initially, then curves, forming the aortic arch, and descends caudally adjacent to the spine.Sometimes people with inherited connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, get thoracic aortic aneurysms. Signs and ... Thoracic aortic dissection and perforation are rare complications of TAVR occurring in 0.2% to 0.3% of cases. 1, 2 There are numerous possible mechanisms by which an aortic injury can develop during TAVR, including wire perforation, interaction of the delivery system with tortuous aorta, and retrieval of a balloon or valve system. Open surgery ... Unfolded aorta. An unfolded aorta is a radiological finding which is commonly seen in older people. The chest radiograph shows slight lengthening of the thoracic aorta resulting in some tortuosity. It is not significant, but should not be confused with other sinister causes of mediastinal widening.At 70 yrs old I had an aortic aneurysm and a quadruple by-pass. Left the hospital two days early. They said it was a first. Was not crazy about the hospital, but the surgeon was great. I was in good physical condition going in. Started rehab two weeks later in better condition than most that left rehab three weeks later.Tortuosity of the descending thoracic aorta is increased in Type B dissection patients who develop enlarging thoracoabdominal aneurysms or ruptures . Tortuosity may reflect pathologic remodeling in response to progressive structural compromise of the vascular media due to genetic mutations, atherosclerosis or hemodynamic stress. ...anatomic view of the aorta in a plane perpen-dicular to blood flow. The double oblique method corrects the oblique course of the ascending aorta along with accounting for aortic tortuosity.17,18 This technique is the standardized approach recommended in guideline statements, as nonstandard ap-proaches to measurements may lead to unre-if you look at DISTORTION you get distortion aorta =747.29 go to your tubular and 747.29= DILATION OF AORTA.... go back to index look up dilation. you get DILATION/AORTA=SEE ALSO ECTASIA. LOOK UP ECTASIA, YOU GET ectasia aorta=see also ectasia aortic. aortic abdominal= 447.72. aortic thoracic= 447.71.

Objective Tortuosity in the descending thoracic aorta (DTA) comes with aging and increases the risk of endoleaks after TEVAR. With this report, we would like to define and classify tortuosity in the DTA of patients with thoracic aortic disease. Methods Retrospective case–control study of two hundred seven patients, comparing sixty-nine controls without aortic disease (CG), to sixty-nine .... David picher obituary

thoracic aorta mildly tortuous

Dilation of the ascending aorta entails a high risk of dissection or aortic rupture in the absence of surgical treatment. Overall, it represents 50% of all thoracic aneurysms, but can be separated into two distinct entities, according to aetiology and surgical management: (1) the aortic root aneurysm, concerning the initial portion, the so called “aortic root”, that …The dysphagia is relieved when only soft or pureed foods are taken. Treatment of congestive heart failure may improve the dysphagia by diminishing the size of the left heart. Summary Compression of the distal esophagus by sclerotic tortuosity of the thoracic aorta may be the cause of dysphagia. Two cases are reported.Plaque smaller than 1 millimeter in diameter is considered “mild” and carries a lower risk of complications. Talk with your provider about how the severity of plaque buildup in your aorta and what that means for you.Furthermore, the aortic branches exhibited increased tortuosity with advancing age. These findings collectively suggest that age-related alterations in vessel structure contribute to arterial tortuosity, particularly in the thoracic aorta and its branches. Gender has been identified as a potential factor influencing arterial tortuosity.Treatment. Thoracic aortic aneurysms are bulges (dilations) in the wall of the aorta in the part that passes through the chest (thorax). Thoracic aortic aneurysms may not cause symptoms, or they may cause pain, coughing, and wheezing. Thoracic aortic aneurysms sometimes rupture, which causes excruciating pain (beginning high in the back and ...More caudal images from the same CT scan showed a partially consolidated/compressed left lower lobe along with the thoracic aorta abutting the left posterior ...3 Aug 2015 ... Abdominal, Thoracic, Thoracoabdominal, etc. ... Per AHA Coding Clinic, “Aortic ectasia refers to mild ... aorta (top section of the aorta), the ...Sep 9, 2019 · Tortuous arteries and veins are commonly observed in humans and animals. While mild tortuosity is asymptomatic, severe tortuosity can lead to ischemic attack in distal organs. Clinical observations have linked tortuous arteries and veins with aging, atherosclerosis, hypertension, genetic defects and diabetes mellitus. Thoracic aortic aneurysms are often found when an imaging test is done for a different reason. If you have symptoms of a thoracic aortic aneurysm, your health care provider may ask about your …ANSWER: A thoracic aortic aneurysm occurs when one or more areas along the wall of the aorta — the body's largest blood vessel — becomes weak or damaged. The aorta carries oxygen-filled blood from the heart to the body, including the brain. With time, the pressure of blood flowing through the weakened area can cause it to enlarge or bulge ...Q25.46. ICD-10 code Q25.46 for Tortuous aortic arch is a medical classification as listed by WHO under the range - Congenital malformations, deformations and chromosomal abnormalities .I have been having problems with double vision, headaches and vertigo. mri showed vascular tortuosity. tortuosity of the vertevrovasilar junction of the atheromatous. along with mild asymmetry of the ventricular system with right predominance? 5 doctors weighed in across 3 answers. what does tortuosity of the thoratic aorta mean?:Key Points. Thoracic aortic aneurysm (TAA) is a ≥ 50% increase in diameter of the thoracic aorta. TAAs may dissect, compress, or erode into adjacent structures, cause thromboembolism, leak, or rupture. Median diameter at aneurysm rupture is 6 cm for ascending aneurysms and 7 cm for descending aneurysms.The finding of a mildly dilated aorta is not uncommon on routine imaging of the heart. Examination of the aortic root, ascending aorta and aortic arch is part of the standard reporting for echocardiographers. This paper reviews aortic disease with specific focus on diagnosis, management and further investigations. Treatment. Thoracic aortic aneurysms are bulges (dilations) in the wall of the aorta in the part that passes through the chest (thorax). Thoracic aortic aneurysms may not cause symptoms, or they may cause pain, coughing, and wheezing. Thoracic aortic aneurysms sometimes rupture, which causes excruciating pain (beginning high in the back and ... .

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