33例主动脉瘤或夹层的临床表现与诊断分析

目的 :探讨主动脉瘤或夹层的临床特征与诊断依据。方法 :分组分析患者的临床症状、体征、影像学结果及误诊情况。结果 :主动脉瘤或夹层发作时 95 .0 %有疼痛 ,胸主动脉瘤或夹层 80 .0 %有心包或胸腔积液 ,升主动脉瘤 40 .0 %有主动脉瓣关闭不全 ,腹主动脉瘤 80 .0 %触及搏动包块。 MRI,CT检查主动脉瘤或夹层阳性率 10 0 % ,经胸心超检查升主动脉瘤及 stanford A型夹层阳性率 86 .7% ,心超或腹部 B超检查腹主动脉瘤阳性率 6 6 .7% ,胸片提示 6 2 .5 %胸主动脉瘤纵隔增宽。急性发作患者误诊率 6 5 .0 %。结论 :主动脉瘤或夹层急性发作时疼痛、心包或胸腔积液常见。腹部搏动包块及影像学阳性结果是诊断的特征性依据。MRI,CT阳性检出率极高。

Analysis of clinical features and diagnostic evidences of 33 patients with aortic aneurysms or dissections

Objective:It is to investigate the clinical features and diagnostic evidences of aortic aneurysms or dissections.Methods: The clinical symptoms, signs, imaging characters and misdiagnoses were analyzed respectively.Results: 95.0% patients of aortic aneurysms or dissections felt pain in attack stage, 80.0% patients of thoracic aortic aneurysms or dissections accompanied with pericardial or pleural effusion, 40.0% patients of ascending aortic aneurysms accompanied with aortic incompetence. Abdominal pulsating masses were touched in 80.0% patients of abdominal aortc aneurysms. The positive rate was 100% by CT or MRI to find aortic aneurysms or dissections. The positive rate was 86.7% by echocardiography to find ascending aortic aneurysms and stanford type A dissections. The positive rate was 66.7% by echocardiography or ultrasonography to find abdominal aortic aneurysms. The mediastinum of 62.5% thoracic aortic aneurysms was wide by radiography. Misdiagnostic rate was 65.0% in attack stage. Conclusion:The aortic aneurysms or dissections often accompanies with pericardial or pleural effusion or pain. Abdominal pulsating masses and imaging positive outcome are characteristic diagnosis evidences. It is great high positive rate by MRI or CT.