Uterine artery pseudoaneurysm after subtotal hysterectomy: a case report

<正>Vaginalbleedingisacommonsymptominthe emergency department of obstetrics and gynecology hospitals; however, post-hysterectomy vaginal bleeding is a rare phenomenon. Uterine artery pseudoaneurysm (UAP)is a rare condition that can lead to fatal bleeding and most commonly occurs as a long-term complication after invasive surgery or even in non-invasive procedures, such as cesarean section, myomectomy, dilatation and curettage, cervical conization and vaginal delivery.[1-3] Pseudoaneurysm is...     

彩色多普勒超声对子宫假性动脉瘤的诊断价值

目的探讨彩色多普勒超声对子宫假性动脉瘤的诊断价值。方法回顾性分析19例子宫假性动脉瘤患者的超声诊断资料。结果 19例子宫假性动脉瘤彩色多普勒超声准确诊断18例,漏诊1例。具体表现:子宫肌层或子宫体边缘见混合性包块,包块边缘为稍强或弱回声,内部为无回声区,瘤腔内见旋涡状血流信号;脉冲多普勒可探及双期双向血流频谱。栓塞术后彩色多普勒超声表现为动脉瘤腔内异常无回声区回声增强,瘤腔内血流信号及血流频谱消失或血流明显变慢。结论彩色多普勒超声对子宫假性动脉瘤具有诊断价值,可作为其首选检查方法。     

Ultrasonographic diagnosis and guided compression repair of femoral artery pseudoaneurysm: an update for the vascular nurse.

Rapid advances in technology have led to the use of radiographic technology for therapeutic interventions. This article is an all-inclusive procedure guide for the imaging nurse as well as the bedside nurse caring for the patient before or after the procedure. Key aspects of the nurse's functions are educating the patients to gain their cooperation and improve their understanding of the procedure and post-procedure expectations, physiologic monitoring, and administering sedation and analgesia. Ultrasonographic guided compression repair is a safe, cost-effective first approach to treatment for many femoral artery pseudoaneurysms and does not affect possible surgical intervention if the ultrasonographic guided compression repair attempt fails.     

Postpartum hemorrhage resulting from uterine artery pseudoaneurysm

This article presents a rarely reported cause of late postpartum hemorrhage in a 33-year-old woman. A uterine artery pseudoaneurysm with arteriovenous fistula was identified that required uterine artery embolization.     

Avoidable morbidity in a patient with pseudoaneurysm of the uterine artery after cesarean section

We report the case of a 25-year-old female who presented to the emergency department with vaginal bleeding after a cesarean section. A diagnosis of pseudoaneurysm of the uterine artery was established radiologically; however, failure to consider this potentially life-threatening complication of cesarean section resulted in unnecessary morbidity. Doppler sonography and CT have been shown to be excellent tools for accurate diagnosis of uterine artery pseudoaneurysms, and selective arterial embolization remains the intervention of choice.     

Delayed postpartum hemorrhage resulting from uterine artery pseudoaneurysm rupture

Background

Rupture of a uterine artery pseudoaneurysm is an uncommon, but life-threatening, cause of postpartum hemorrhage. Cesarean delivery is the most common cause.

Objectives

Prompt recognition and management are critical in severe vaginal bleeding. A diagnosis of pseudoaneurysm of the uterine artery can be established radiologically, such as with color Doppler ultrasonography and computed tomography. Angiography confirms the diagnosis. This condition can be treated with selective arterial embolization.

Case Reports

We describe three cases of postpartum hemorrhage caused by rupture of pseudoaneurysms of the uterine artery after cesarean section.

Conclusion

Uterine arterial pseudoaneurysm rupture is an infrequent, life-threatening cause of delayed postpartum hemorrhage requiring prompt diagnosis and treatment. Early crystalloid infusion and blood transfusion are essential. The initial management and stabilization of uterine artery pseudoaneurysm postpartum hemorrhage requires aggressive resuscitation. Arterial embolization should be considered the definitive treatment.     

腘动脉陷迫综合征的超声表现

目的探讨腘动脉陷迫综合征(PAES)的声像图特征。方法对5例经下肢动脉造影或MRA证实为PAES患者进行灰阶及彩超检查。结果直接征象:5例患肢均可显示腘动脉向内侧不同程度移位,3例管腔呈节段性狭窄或闭塞,2例狭窄或闭塞远端见局限性动脉瘤形成;间接征象:2例管腔通畅者作伸膝和足背屈试验时胫后动脉血流明显减弱或消失。结论彩色超声多普勒具有简便、非侵袭性以及费用低等优点,在PAES诊断中起着重要作用。     

Ultrasonographic characterization of the uterine artery in the nonestrus bitch

The canine species is often used as an experimental animal model in medicine. Doppler ultrasound of uterine arteries has important clinical implications in obstetrics and gynecology in women and animal species. To our knowledge, the ultrasonographic features of uterine arteries in the bitch have not been reported. Thus, an ultrasonographic technique to locate the uterine arteries in the bitch is described in this study. A total of 11 nonspayed nonestrus bitches underwent abdominal ultrasound examination. Pulsed-wave, color and power Doppler settings were used to detect the location and characterize the flow of the uterine arteries. Mean values for systolic peak velocity, diastolic peak velocity, diastolic reversal flow and resistive index were calculated. Uterine arteries had a high pulsatility flow in all cases. Future work is needed to fully assess the clinical importance of the uterine artery flow in the bitch, as well as to study possible waveform changes at different estrus phases and throughout gestation. (E-mail: fernandoxy@yahoo.com)     

Endoscopic diagnosis of a right hepatic artery pseudoaneurysm

Hepatic artery aneurysms are rare occurrences with diverse etiologies. We present a case of a right hepatic artery aneurysm, which was diagnosed at endoscopic retrograde cholangiography (ERC) and treated angiographically. This is the first report where ERC has been critical in delineating the aneurysmal cavity, suggesting the diagnosis and prompting emergency intervention.     

妊娠相关子宫假性动脉瘤的超声表现与临床分析

目的总结妊娠相关子宫假性动脉瘤的超声表现及临床特征,探讨其发病机理。 方法回顾性收集2016年1月至2020年12月于首都医科大学附属北京妇产医院就诊的妊娠相关子宫假性动脉瘤患者21例,对其超声图像及临床特征进行归纳分析。 结果21例患者原发病包括滋养细胞肿瘤7例、瘢痕妊娠2例、早孕期胚物残留10例、胎盘残留或植入2例。19例患者血hCG异常增高,中位数2573.30（60.00,12001.30）IU/L。18例经病变局灶切除或全子宫切除获得病理,均于子宫假性动脉瘤处见不同程度退变的绒毛或滋养细胞。所有患者超声表现均符合假性动脉瘤特征,可探及破裂载瘤动脉血液直接流入假腔,裂口处频谱呈高速低阻。8例累及放射动脉、13例累及弓形动脉。 结论绒毛或滋养细胞对子宫肌层的侵蚀是妊娠相关子宫假性动脉瘤发生的重要致病因素,超声检查对子宫假性动脉瘤诊断及疗效评估有重要价值。     

超声诊断脾动脉假性动脉瘤1例

患者男,51岁,因“反复上腹部疼痛不适3年,加重15天”就诊。无高血压、胰腺炎及外伤史。查体:腹软,无压痛及反跳痛,腹部未扪及异常肿块。超声检查:左上腹脾门区探及大小约10.0 cm×9.6 cm的中等回声肿块,形态不规则,边界不清晰,回声不均质,内见范围约6.1 cm×6.0 cm的囊性回声,透声不清晰(图1A),超微血流成像(superb microvascular imaging,SMI)技术囊性回声内可探及漩涡状血流信号(图1B),PW测得动脉血流频谱,CDFI显示血流与脾侧脾动脉关系紧密(图1C)。超声诊断:左上腹脾门区脾动脉假性动脉瘤(splenic artery pseudoaneurysm,SAPA)。增强CT:脾胃间隙见一团状高低混杂密度影,增强动脉期低密度区轻度强化,静脉期明显强化。CT诊断:脾胃间隙混杂密度占位,考虑血肿伴活动性出血。DSA:脾动脉远端造影,可见造影剂外渗入囊腔(图1D),诊断为SAPA。该患者行脾动脉栓塞术,术后超声复查示瘤腔闭塞、动脉破口无血流信号。     

口服甘露醇充盈肠腔后输尿管中下段结石的超声诊断

超声显像是诊断肾及输尿管结石的常用方法。但因肠气干扰,中下段输尿管结石难被显示〔１〕。甚有报道中下段输尿管为超声显像的盲区〔２〕。口服甘露醇可使肠腔液性充盈。我们以此为透声窗口,显著提高了中下段输尿管结石的超声诊断率。１资料与方法１１临床资料根据临床表现、尿常规检查、Ｘ线腹平片（ＫＵＢ）、静脉尿路造影（ＩＶＵ）、常规Ｂ超和口服甘露醇后Ｂ超检查出中下段输尿管结石患者８３例。男５８例,女２６例。年龄１４～６７岁（３８７±１７７岁）。１２方法采用日立ＥＵＢ-４０型线阵实时Ｂ超诊断仪,探头频率３５ＭＨｚ及５…     

Ultrasonic diagnosis of ureteral injury after laparoscopically-assisted vaginal hysterectomy.

Ureteral injuries are uncommon but serious complications of laparoscopically-assisted vaginal hysterectomy. The ureter is particularly at risk for inadvertent injury when the cardinal-uterosacral ligament complex is coagulated and divided below the uterine vessels. We present two recent cases which describe the application of transabdominal ultrasound including color Doppler mapping in the diagnosis of ureteral injury after laparoscopically-assisted vaginal hysterectomy. Transabdominal ultrasound including color Doppler mapping has great diagnostic potential as a method for non-invasive evaluation of post-operative ureteral conditions. Ultrasonic triads (absence of a ureteric jet, ascites, and the presence or absence of hydronephrosis) are capable of differentiating diagnosis of complete, partial, or nonobstructive surgical ureteral injuries.     

彩超诊断移植肝肝固有动脉假性动脉瘤1例

病例男,50岁,既往因＂乙肝肝硬化并发肝癌,肝功能失代偿＂行经典原位肝移植术,术后14天患者突发右上腹痛,超声检查肝门处可探及范围约2.0cm×1.5cm液性暗区,暗区不清晰,内有暗淡光点及少许光带反射,CDFI显示未见血流信号,超声提示：肝门处局限性积液。后行经内镜鼻胆管引流术（ENBD）造影确诊为胆管瘘,行经皮肝穿刺胆道置管引流术（PTCD）后患者症状缓解,术后30天患者突现上腹部剧痛伴有腹胀,PTCD管引流出血性液体并伴＂柏油样＂便,     

Atypical pseudoaneurysm after mitral valve replacement: Doppler echocardiographic diagnosis.

Ventricular pseudoaneurysm is a rare complication of mitral valve replacement or myocardial infarction. Typically, a ventricular pseudoaneurysm appears as an echocardiographic lucency posterior and lateral to the left ventricle and is best seen from the parasternal long axis and apical four-chamber views. We present an atypical case of left ventricular pseudoaneurysm that tracts posterior and lateral to the right ventricle that was best visualized from the subcostal and low parasternal windows with medial angulation. Doppler imaging confirmed the diagnosis by demonstrating to-and-fro flow between the left ventricle and the cavity located behind the right ventricle. This case emphasizes the importance of the use of multiple echocardiographic windows.     

颈动脉夹层的超声表现及漏诊分析

目的 探讨颈动脉夹层超声表现，分析超声检查的漏诊原因。方法 回顾性分析经高分辨率MRA/CTA/DSA确诊的28例颈动脉夹层的超声图像，观察颈动脉夹层的声像图特征，分析超声漏诊原因。结果 28例颈动脉夹层中，15例超声诊断明确，13例超声漏诊，诊断符合率53.57%（15/28），漏诊率46.43%（13/28）。15例颈动脉夹层的超声表现为"双腔征"7例，壁内血肿6例，闭塞或重度狭窄提示颈动脉夹层2例；15例中合并血流异常15例，合并频谱异常7例；超声漏诊13例中，6例超声阴性，7例仅提示重度狭窄或闭塞及频谱异常。结论 颈动脉夹层超声表现以"双腔征"和壁内血肿较常见。年轻且无动脉粥样硬化者，若出现颈动脉重度狭窄或闭塞以及血流动力学异常时，需高度警惕颈动脉夹层。