1例先天性颈内动脉缺如影像学特点

目的：分析性先天性颈内动脉缺如的影像学特点。方法：回顾分析1例先天性颈内动脉缺如的临床症状和影像学特点。结果：超声表现为左侧甲状腺上动脉起源于左侧颈总动脉,左侧颈总动脉远端分支未见入颅内的颈内动脉样管腔及血流频谱,且远端分支血流阻力指（RI）较高似颈外动脉样频谱,左侧颈部血管管腔较对侧细。头颈CTA显示左侧颈内动脉不显影,左侧大脑前动脉由对侧大脑前动脉供血,大脑A1段缺如,左侧大脑中动脉由椎基底动脉供血,左侧颈动脉管缺如,确诊为先天性颈内动脉缺如。结论：超声检查便捷、价廉、安全、可实时动态观察,可以作为初步筛查的重要手段,早发现、早预防以减少脑卒中发生的风险。     

先天性颈内动脉发育不良1例报告

先天性颈内动脉发育不良是一种非常罕见的疾病,通常无任何症状,但后期可出现与脑血管供血不足相关的症状.先天性颈内动脉发育不良的诊断主要依靠影像学检查,本文报道了1例因车祸外伤意外发现的左侧先天性颈内动脉发育不良患者的影像学特点,旨在提高介入科、神经外科及影像科医师对本病的认识,避免误诊或漏诊.     

先天性双侧髌骨缺如1例

先天性双侧髌骨缺如临床较为少见，双侧缺如尤为罕见。作者门诊遇先天性双侧髌骨缺如1例，报道如下。     

超声诊断胎儿先天性四肢缺如1例

孕妇 ,2 7岁 ,孕 3产 1,第 1胎为正常女孩 ,第 2胎孕 5月时流产。平时健康 ,月经规则 ,无接触放射线及有害物质史。配偶正常。亲戚及邻居中无胎儿畸形史。现孕 5月 ,行常规门诊Ｂ超检查。超声显示 :胎儿头位 ,双顶径 48ｍｍ ,胎心 138次 /ｍｉｎ ,胎盘位于子宫后壁 ,厚 17ｍｍ ,羊水最大深度 5 2ｍｍ ,胎体周围未测及肢体图像 ;胎儿脊柱弯曲 ,以颈椎为明显 ;双侧肾脏均未明显显示 ;胎头双侧脉络丛部位各显示一无回声区 ,最大 8ｍｍ× 6ｍｍ ,边界清晰、规则 ;未测及其他明显异常的脏器 (图 1,2 )。超声诊断 :①中孕 ,胎儿存活 ;②胎儿畸形 (…     

先天性胆囊缺如超声误诊1例

患者,女性,36岁。间断性右上腹绞痛十余年,进食油腻食物后加重。曾多次就诊均按胃痉挛处理,给予解痉药后症状缓解,自感消化不良十余日后恢复正常。近几年来症状加重,曾多次在市级医院就诊做B超检查,诊断为胆囊多发结石、胆囊萎缩。X线静脉胆囊造影结果:胆囊区似有梨状显影,提示胆囊显影不     

先天性胆囊缺如一例

患者,女性,51岁。主诉:右上腹部疼痛4年余,呈持续性隐痛,阵发性绞痛,向右肩、右下腹放射。在当地二家县医院作B超检查诊断为“慢性胆囊炎,胆囊多发性结石”。复发时与饮食无关。近期腹痛加剧,发作多次。曾出现一次轻度黄疸,但很快消退。来本院要求手术治疗。术前作B超检查:肝脏大小形态正     

先天性胆囊缺如：附2例及文献复习

先天性胆囊缺如系胆囊的先天性发育畸形,临床诊断困难,常需手术或胆道造影方能确诊。我院曾收治1例,加上院外会诊1例,均经手术证实,现结合文献复习,报道如下: 例1,女,58岁,因反复上腹部疼痛伴畏寒,发热1~+年于1988年10月28日住院手术治疗。术中发现总胆管扩张约1.2cm,内有多枚混合结石,在肝外正常解剖部位未发现胆囊,肝、胰未见异常。行总胆管切开取石,“T”管引流,术后半月经“T”管逆行造     

先天性胆囊缺如一例

先天性胆囊缺如临床罕见,诊断困难,误诊率较高。该文报告1例因消化道症状和明确的超声诊断为胆石症的患者行胆囊切除术及胆总管探查术,术中探查未发现胆囊,同时伴胆总管结石,术后患者症状消失。该病例提示对先天性胆囊缺如的认识有助于临床医生对可疑病例的鉴别,在诊断和治疗中对应注意的问题进行临床探讨分析,从而避免不必要的手术探查和降低并发症的危险。     

颈内动脉-海绵窦瘘1例

患者男,18岁.患者于14天前因车祸左枕后部着地.X线示颅底骨折.在外院治疗2周,之后右侧眼球逐渐外突,略感胀痛.我院门诊以颅脑外伤收入科.专科检查:右眼上睑活动受限,右眼球向上、向鼻侧及向下均受限,双眼外展受限,右眼球外突,结膜充血,呈紫红色,左眼余未见异常.眼底见视盘色淡,余(-).彩超示:双侧眼球对比扫查,左、右眼轴均是21 mm,晶状体及玻璃体内透声清晰,球后组织未见异常,右眼静脉内径1.78～3.17 mm,PW示静脉动脉化频谱,流速67 cm/s(见图).诊断:右眼静脉扩张,结合病史,考虑为颈内动脉-海绵窦瘘.CT诊断:右侧眼球后炎性改变,动-静脉瘘可能.     

颈内动脉狭窄或闭塞后交通动脉的DSA和MRA评价

目的 应用DSA、MRA研究颈内动脉狭窄或闭塞患者后交通动脉的变化。方法 分析74例颈内动脉狭窄或闭塞患者以及120例脑血管正常表现者的DSA和MRA结果。结果 疾病组中颈内动脉狭窄或闭塞同侧后交通动脉DSA出现率和对照组间无明显差异(P>0.05);在MRA上明显高于对照组(P<0.01);同侧后交通动脉的DSA和MRA测量值均较对照组增大(P<0.01)。对照组中,后交通动脉DSA出现率高于MRA(P<0.01),DSA和MRA其测量值无统计学差异(P>0.05);疾病组中,后交通动脉DSA出现率高于MRA(P<0.05),单侧和双侧病变其出现率和增粗率无明显差异。结论 后交通动脉在颈内动脉阻塞中有重要代偿作用,DSA上增粗及MRA上出现和增粗均有一定代偿意义。DSA对后交通动脉的评价有很高价值,MRA无创、整体性好,能从功能上评价其作用。     

颈内和大脑中动脉狭窄与闭塞MR脑灌注的MTT、TTP延迟表现

目的探讨单侧ICA/MCA狭窄与闭塞患者MR脑灌注的MTT和TTP表现.方法90例患者(ICA 62例、MCA 28例)行MR脑灌注检查,比较MTT和TTP灌注延迟体积,分析灌注延迟表现与病变动脉及其狭窄程度关系.结果90例患者MTT和TTP灌注延迟体积无显著性差异,延迟表现分三型:Ⅰ型仅累及MCA区,Ⅱ型仅累及分水岭区,Ⅲ型累及MCA和分水岭区.ICA患者Ⅲ型40例(65%),MCA患者Ⅰ型24例(86%).结论MTT、TTP能够敏感显示灌注损伤,对ICA/MCA重度狭窄或闭塞诊断、治疗及脑梗死发病机制研究有重要价值.     

Primary balloon angioplasty for chronic occlusion of intracranial internal carotid artery: A case report

Chronic occlusion of large intracranial arteries is the main cause of ischemic stroke in China. Patients with symptomatic intracranial artery occlusion and hemodynamic impairment are at high risk of recurrent stroke. Chronic occlusion of the intracranial segment of the internal carotid artery is a common type of intracranial artery occlusion. Medical management is regarded as the standard treatment for this disease. With the development of endovascular treatment, some patients with chronic cerebral artery occlusion have achieved satisfactory results with endovascular therapy. We reported a patient with symptomatic chronic occlusion of the ophthalmic segment of the internal carotid artery. Simple balloon angioplasty was performed, and the occluded ophthalmic segment of the internal carotid artery was successfully recanalized without perioperative complications. At 4 months follow-up, the internal carotid artery remained patent and perfusion of the right cerebral hemisphere improved dramatically. In addition, we briefly reviewed the relevant literature.     

Acute onset of massive epistaxis due to post-traumatic cavernous internal carotid artery pseudoaneurysm: A case report

Rationale: Cavernous internal carotid artery (ICA) pseudoaneurysm caused by non-penetrating head trauma is a rare cause of massive epistaxis. The sudden onset of epistaxis due to such a fatal aneurysm protruding into the sphenoid sinus is extremely rare in clinical practice. The management is often challenging because of anatomical inaccessibility of the bleeding point. Patient's concern: A 42-year-old man with a history of head trauma showing an ICA aneurysm eroding the sphenoid sinus followed by massive epistaxis. Diagnosis: A computerized tomography (CT) scan showed a fracture in the sphenoid sinus. CT angiogram revealed cavernous ICA pseudoaneurysm. Interventions: Endovascular coil embolization. Outcomes: The patient recovered well and was discharged without any neurological deficits Lessons: Cavernous ICA pseudoaneurysm may lead to a life-threatening situation. If a patient has a history of head trauma, post-traumatic cavernous ICA pseudoaneurysm should be considered a differential diagnosis of massive epistaxis.     

Bilateral internal carotid artery dissection from vomiting

Dissection of the internal carotid artery is responsible for approximately 5% of ischemic strokes in adults. The pathophysiology of dissection can be either traumatic or spontaneous. The true incidence of spontaneous dissection is unknown. Once considered very rare, an increased awareness, combined with noninvasive evaluation by ultrasound and magnetic resonance angiography, has demonstrated a more frequent occurrence. Trivial trauma (ie, rather than external blunt or penetrating trauma) such as vomiting has rarely been documented as causing bilateral dissection. It is well recognized by neurologists but often not by other physicians. Prognosis is good, but delay in diagnosis may result in residual neurologic deficits. It should therefore be suspected early, especially in younger patients presenting with transient ischemic attacks or stroke.     

单侧和双侧颈内动脉狭窄或闭塞侧支循环途径的研究

目的研究单侧和双侧颈内动脉狭窄或闭塞的侧支循环方式。方法经DSA、MRA确诊的颈内动脉狭窄或闭塞者95例,分为单侧和双侧病变组。分析DSA、MRA结果,对比两组病例侧支循环方式。结果DSA和MRA上,单侧病变组前交通动脉出现率明显高于双侧病变组(P<0.05),后交通动脉出现率在两组间无统计学差异(P>0.05)。DSA上,眼动脉出现率在两组间无统计学差异;双侧病变组眼动脉增粗率(57.9%)高于单侧组(32%)。双侧病变组软脑膜吻合支出现率明显高于单侧组(P<0.01)。结论单侧和双侧颈内动脉狭窄或闭塞的侧支方式不同,单侧病变主要通过前交通动脉、同侧后交通动脉等代偿,双侧病变主要侧支是后交通动脉、眼动脉和软脑膜吻合支。     

Congenital absence of the portal vein in an adult woman: A case report

Summary Congenital absence of the portal vein is a rare malformation. Mesenteric and splenic venous blood bypasses the liver and drains into the renal veins or directly into the inferior vena cava. The malformation occurs predominantly in females and children and is often associated with other anomalies such as hepatic tumors, cardiac malformations and skeletal abnormalities. We describe a 23-year-old female with congenital absence of the portal vein associated with variant origin of the hepatic artery from the superior mesenteric artery. Additional anomalies were not present. The patient is in good condition. Laboratory tests showed elevated total bilirubin; other liver parameters were within normal range. The absence of the portal vein was confirmed by MR angiography, which revealed that the upper part of the superior mesenteric vein and the splenic vein drained into the left renal vein. A liver biopsy showed no signs of cirrhosis. Yearly follow-up with laboratory tests and ultrasonography was recommended to our patient. According to the literature, the prognosis of this patient depends on the presence of cardiac defects and liver tumors. There is little information on the outcome of patients with congenital absence of the portal vein; only long-term follow-up investigations will provide answers to the numerous remaining questions.

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Angeborenes Fehlen der Pfortader bei einer erwachsenen Frau: ein Fallbericht

Zusammenfassung Das angeborene Fehlen der Pfortader ist eine sehr seltene Fehlbildung. Das venöse Blut aus dem Intestinum und der Milz umgeht die Leber und drainiert direkt in die Nierenvenen oder in die untere Hohlvene. Es tritt vor allem bei Kindern auf und das weibliche Geschlecht ist häufiger betroffen. Assoziert sind oft Missbildungen des Herzens und des Skeletts. Weiters kommt es zu einem gehäuften Auftreten von Lebertumoren. Wir berichten über eine 23-jährige Patientin mit Pfortaderaplasie und variantenhaften Abgang der Arteria hepatica aus der Arteria mesenterica superior. Zusätzliche Fehlbildungen traten nicht auf. Die Patientin ist in gutem Allgemeinzustand. Im Labor zeigte sich ein erhöhtes totales Bilirubin, andere Leberparameter waren im Normbereich. Das Fehlen der Pfortader wurde durch eine MR-Angiographie bestätigt. Hier zeigte sich, dass die Milzvene und die obere Mesenterialvene in die linke Nierenvene drainieren. Eine Leberbiopsie wurde auch durchgeführt und zeigte keine Zeichen einer Zirrhose. Wir haben mit der Patientin jährliche Labor- und Ultraschallkontrollen vereinbart. Bezugnehmend auf die Literatur, ist die Prognose abhängig vom Auftreten von Herzfehlbildungen und zusätzlichen Lebertumoren. Derzeit besteht wenig Information über den klinischen Verlauf dieser Patienten. Erst weitere, über einen längeren Zeitraum laufende Nachsorgeuntersuchungen werden diese Fragen beantworten können.