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1.
Both middle colic artery (MCA) aneurysm and spontaneous dissection of the superior mesenteric artery (SMA) are rare. We report the first case of concomitancy of both conditions, diagnosed by ultrasonography and CT angiography. A 56-year-old man with abrupt abdominal pain and hypovolemic shock was diagnosed initially with ruptured MCA aneurysm by color Doppler ultrasonography. Computed tomography and angiography confirmed MCA aneurysm and showed that it was arising from the false lumen of an SMA dissection and was probably associated with segmental arterial mediolysis. The MCA aneurysm was treated successfully by transcatheter coil embolization, and the SMA dissection was treated conservatively. 相似文献
2.
目的 探讨彩色多普勒超声(CDFI)在肠系膜上动脉(SMA)病变中的应用。
方法 应用CDFI对19例临床怀疑SMA病变所致的急腹症患者进行SMA检查及部分患者术后随访。观察的内容包括SMA管腔结构、血流速度(PV)和阻力指数(RI),并与其他影像检查对照分析。
结果 19例患者中超声提示:SMA血栓致闭塞3例;SMA粥样硬化管腔狭窄14例;SMA夹层动脉瘤2例。以上患者均经MRA或DSA检查证实,其中2例SMA夹层动脉瘤患者放置支架治疗,1例SMA血栓闭塞患者做了X-线下取栓、溶栓,4例SMA动脉粥样硬化管腔狭窄的患者放置支架。
结论 CDFI对SMA病变诊断率高,能够客观反映病变的部位、程度和血流动力学的改变,也是评价治疗效果有效的方法。 相似文献
3.
目的探讨急性肠系膜上动脉(SMA)血栓栓塞(SMAT)的MSCT表现。方法回顾分析28例急性SMAT患者临床资料及MSCT表现,所有患者均行MSCT平扫、动脉期和静脉期增强扫描,所得图像进行三维重组。结果28例患者中单纯SMAT20例,孤立性肠系膜上动脉夹层继发血栓栓塞5例,主动脉夹层累及肠系膜上动脉假腔继发血栓栓塞3例。MSCT平扫SMA内密度增高22例,等密度6例。增强扫描及CTA显示SMA中度狭窄6例、重度狭窄4例、闭塞18例。14例肠壁增厚伴强化异常,8例肠管扩张、肠壁变薄且不强化,6例肠壁厚度及强化程度无变化。另外,肠系膜缆绳征(5例),肠壁积气、门静脉一肠系膜上静脉积气(2例),麻痹性肠梗阻(5例),腹腔各液(5例),Riolan动脉弓扩张(5例)。结论MSCT增强扫描及图像后处理技术能快速准确诊断SMAT并判断肠缺血程度,对临床治疗具有重要意义。 相似文献
4.
《Journal of infection and chemotherapy》2021,27(10):1513-1516
Mycotic aneurysms are sometimes seen in patients with infective endocarditis. We report a case of infective endocarditis with multiple mycotic aneurysms. Although antibiotics were effective, mycotic aneurysms appeared in the cerebral, hepatic, and gastroepiploic arteries. A 55-year-old man presented with mitral valve endocarditis due to Streptococcus oralis. Surgical treatment was deferred because of cerebral hemorrhage. After antibiotic initiation, his fever and C-reactive protein levels declined, and blood culture was negative. However, he experienced repeated cerebral hemorrhage and the number of cerebral mycotic aneurysms increased. Additionally, his spleen ruptured and the number of mycotic aneurysms in the hepatic and gastroepiploic arteries increased. After embolization for mycotic aneurysm and mitral valve replacement, no mycotic aneurysms appeared. Regardless of whether laboratory data improve or not, multiple mycotic aneurysms sometimes appear, and cardiac surgery for infection control should be considered in the early phase. 相似文献
5.
Wadhwani R Modhe J Pandey K Gujar S Sukthankar R 《Journal of clinical ultrasound : JCU》2001,29(4):247-249
We report a case of dissecting aneurysm of the superior mesenteric artery (SMA) diagnosed on gray-scale and color Doppler sonography and confirmed on angiography. Spontaneous dissection of the SMA is rare, and there are few reported cases of the color Doppler sonographic findings. Gray-scale sonography revealed an aneurysmal dilatation of the SMA 3-4 cm from the SMA's origin, with an echogenic linear membrane (an intimal flap) within the aneurysm. Color Doppler sonography showed color flow within the aneurysm and showed that the intimal flap separated the aneurysm into 2 lumina. Spectral analysis revealed anterograde flow in the anterior (ie, true) lumen and retrograde flow in the posterior (ie, false) lumen. 相似文献
6.
Gunduz A Turedi S Mentese A Karahan SC Hos G Tatli O Turan I Ucar U Russell RM Topbas M 《The American journal of emergency medicine》2008,26(2):202-205
Ischemia-modified albumin (IMA) is a sensitive marker of myocardial ischemia, skeletal muscle ischemia, pulmonary embolism, and stroke. However, there are no studies showing whether IMA increases in mesenteric ischemia. The aim of this study was to determine whether IMA was elevated in acute mesenteric ischemia. This case-controlled study was performed in an emergency department of a university hospital. The measurement of IMA levels in patient plasma yielded means of 0.264 +/- 0.057 absorbance units (ABSU) in the thromboembolic occlusion of the superior mesenteric artery (SMA) group and 0.163 +/- 0.025 ABSU in the control group. When plasma IMA levels in the thromboembolic occlusion SMA group were compared with those in the control group, statistically significant increases in IMA were observed in the occlusion group (P = .003). Findings indicating that IMA may have a place in the diagnosis of acute mesenteric embolism were obtained in this preliminary study. Further prospective studies are needed to see if IMA is clinically useful in the early detection of thromboembolic occlusion of the SMA. 相似文献
7.
Aneurysms of the superior mesenteric artery (SMA) and its branches are rare. We describe three patients with aneurysms in the SMA or its branches found at angiography in our department. The importance of mesenteric aneurysms and different procedures for treatment are discussed. 相似文献
8.
Acosta S Block T Björnsson S Resch T Björck M Nilsson T 《The Journal of emergency medicine》2012,42(6):635-641
Background
Acute superior mesenteric artery (SMA) occlusion leads to acute intestinal ischemia and is associated with high mortality. Early diagnosis is often missed, and confounding factors leading to diagnostic delays need to be highlighted.Objectives
To identify potential diagnostic laboratory pitfalls at admission in patients with acute SMA occlusion.Methods
Fifty-five patients with acute SMA occlusion were identified from the in-hospital register during a 4-year period, 2005–2009.Results
The median age was 76 years; 78% were women. The occlusion was embolic in 53% and thrombotic in 47% of patients. At admission, troponin I was above the clinical decision level (> 0.06 μg/L) for acute ischemic myocardial injury in 9/19 (47%) patients with embolic occlusion. Elevated pancreas amylase and normal plasma lactate were found in 12/45 and 13/27, respectively. A troponin I (TnI) above the clinical decision level was associated with a high frequency of referrals from the general surgeon to a specialist in internal medicine (p = 0.011) or a cardiologist (p = 0.024). The diagnosis was established after computed tomography angiography in 98% of the patients. The overall in-hospital mortality rate was 33%. Attempting intestinal revascularization (n = 43; p < 0.001), with a 95% frequency rate of completion control of the vascular procedure, was associated with a higher survival rate, whereas referral to the cardiologist was associated with a higher mortality rate (p = 0.018).Conclusion
Elevated TnI was common in acute SMA occlusion, and referral to the cardiologist was found to be associated with adverse outcome. Elevated pancreas amylase and normal plasma lactate values are also potential pitfalls at admission in patients with acute SMA occlusion. 相似文献9.
目的 探讨胃肠超声造影诊断肠系膜上动脉压迫综合征(SMAS)的价值.方法 经螺旋CT检查证实的SMAS患者29例,全部进行口服胃窗超声造影检查,分析SMAS的经口服胃窗的超声造影表现.结果 29例患儿胃肠超声造影均可显示明显减少的肠系膜上动脉(SMA)-腹主动脉角度和SMA-腹主动脉距离,仰卧位患儿出现由SMA引起的十二指肠压迹和"漏斗形"、"葫芦形"图像,可见十二指肠近端扩张和造影剂来回流动.经口胃肠超声造影检查和CT检查诊断SMAS具有高度的一致性.结论 胃肠超声造影检测SMAS具有特征性表现,并对筛选可疑的SMAS病例有一定作用.Abstract: Objective To explore oral contrast-enhanced ultrasonography findings in superior mesenteric artery syndrome (SMAS).Methods Twenty-nine patients with SMAS were examined using oral contrast-enhanced ultrasonography,which was confirmed by contrast-enhanced spiral computerized tomography.Results Abdominal ultrasonography with oral contrast-enhanced ultrasonography revealed a significant reduction of the SMA angle and diminished SMA-aorta distance in 29 subjects.Duodenum was showed the indentation and "funnel shaped" or "dumbbell shaped" findings which was caused by pressure of the SMA in patients with recumbent position.The proximal part of duodenum expanded distinctively with contrast media movement fro.Ultrasonography and CT examinations had a good agreement in diagnosing pathological aortomesenteric angle and distance.Conclusions Oral contrast-enhanced ultrasonography presents characteristic findings in patients with SMAS,which is useful in epidemiological screening of suspicious cases of SMAS in children. 相似文献
10.
Timothy Yu Chang Lee MD Tze Yu Lee MD Yu Fan Cheng MD 《The American journal of emergency medicine》1998,16(7):714-716
A 60-year-old man was admitted to a hospital for evaluation of intermittant fever, dysphagia, hoarseness, and general chest discomfort. Great vessel mycotic aneurysm was suspected when antibiotic trials failed and chest X-ray showed paraaortic mass with pleural effusion mimicking mediastinitis. Although the correct diagnosis of mycotic aneurysm of innominate artery was made thereafter and vigorous treatment was initiated immediately, this patient succumbed to overwhelming sepsis, probably due to a 2-week delay in another hospital. This case is reported to remind readers of the possibility of this unusual location of mycotic aneurysm. A high index of suspicion should be maintained to make an earlier diagnosis and obtain better prognosis. Computed tomography and 3D magnetic resonance angiography also significantly improve the diagnosis when mycotic aneurysm location is unusual and presentation is equivocal. 相似文献
11.
Spontaneous, isolated dissection of the superior mesenteric artery (SMA) and celiac artery (CA) is rare. Although there are known risk factors, there is no particular mechanism that is common to vascular dissections. The objectives of this study were to review the current literature on diagnosis and treatment of isolated SMA and CA dissection, and to review aortic complications in giant cell arteritis, Takayasu arteritis, and polyarteritis nodosa. Giant cell arteritis, Takayasu arteritis, and polyarterteritis nodosa are vasculitides that are associated with SMA and CA dissection. An interesting aspect of this case is that the patient was a healthy person before presentation, and ultimately, did not have an underlying etiology to explain the dissection. In addition, the patient was successfully managed without operative intervention. Although there are known risk factors in patients who present with isolated, spontaneous SMA and CA dissection, the pathogenesis is still unclear. The prognosis has improved significantly with the early use of computed tomography angiography to diagnosis this entity. Although most cases require surgical intervention, there are some, as in this case, that are managed non-operatively. 相似文献
12.
彩色多普勒超声检查在正常成人肠系膜上动脉血流参数测定中的应用 总被引:1,自引:0,他引:1
王跃龙 《临床和实验医学杂志》2008,7(12):19-20
目的测量正常人肠系膜上动脉(SMA)的血流参数。方法应用彩色多普勒血流显像测量160例健康人SMA的血流参数。结果SMA直径(D)、收缩期峰值流速(PSV)、平均流速(Vmean)、阻力指数(RI)、搏动指数(PI)男女性别之间、年龄组之间差异无显著性。结论确定了正常人SMA血流参数的正常值范围。 相似文献
13.
H. Pargger S. Staender W. Studer O. Schellscheidt M. J. Mihatsch D. Scheidegger K. Skarvan 《Intensive care medicine》1997,23(1):91-99
Objective: To investigate the effects of superior mesenteric artery (SMA) flow reduction on the jejunal intramucosal pH (pHi) and to compare these effects with corresponding changes of mesenteric oxygen transport variables and oxygen tensions on
the surfaces of the jejunal serosa and mucosa.
Design: Prospective, randomized, controlled, experimental study.
Setting: Animal research laboratory.
Subjects: 20 domestic pigs.
Interventions: Mechanical flow reduction in the SMA. The animals were randomized to have an SMA flow of 0%, 25%, 38%, 50% or 100% (control).
Measurements and main results: Measurements (baseline, ischemia, reperfusion) consisted of hemodynamic and oxygen transport variables, SMA blood flow,
mesenteric oxygen transport variables, pHi and oxygen tensions of the jejunal serosa and mucosa. Flow reduction in the SMA resulted in a significant decrease of pHi indicating ischemia earlier than mesenteric oxygen transport variables. The relationship between mesenteric oxygen delivery
(DO2ms) and pHi during acute ischemia is best described by a sigmoid curve. There was a linear correlation between the changes of the jejunal
surface oxygen tensions and pHi due to SMA flow reduction.
Conclusion: The sigmoid relationship between pHi and DO2ms indicated that pHi is a sensitive parameter for detecting ischemia at 50% of the baseline oxygen delivery and that below 25% there was no further
decrease of pHi. In contrast, mesenteric and whole body oxygen transport parameters were not indicative of impaired mucosal oxygen supply.
Received: 11 March 1996 Accepted: 4 October 1996 相似文献
14.
肠系膜上动脉压迫综合征彩色超声的诊断价值 总被引:4,自引:0,他引:4
目的:探讨肠系膜上动脉压迫综合征彩色超声的诊断价值。方法:应用彩色多普勒超声诊断的36例肠系膜上动脉压迫综合征,均经放射线胃肠钡餐透视检查证实。结果:本组超声显像诊断的符合率为100%,肠系膜上动脉(SMA)与腹主动脉(AA)之间夹角及十二指肠通过段距离变小,饮水后其近端十二指扩张明显,左侧卧位时十二指肠潴留消失。结论:CDFI对该病的诊断准确性高无损伤、实时,能同时显示肠管形态,判断血管的位置。 相似文献
15.
Xiaoyan Jiang Jiamin Li Xuehua Zhang Han Chen 《The Journal of international medical research》2021,49(3)
Acute coronary syndrome in the young population is infrequently seen and has a different etiology from that in the elderly population. Giant coronary artery aneurysms are rare and usually asymptomatic, but they can cause acute clinical symptoms such as chest pain or chest tightness. We herein describe a young woman with a history of mitral valve prolapse who developed sudden-onset chest pain. She had mild elevations of her creatine kinase and cardiac troponin levels; however, no ST segment alteration was found on an electrocardiogram, and no abnormal regional wall movement was noted on echocardiography. Cardiac magnetic resonance imaging with late gadolinium enhancement revealed a “mass” at the right coronary artery and linear subendocardial enhancement at the posterior wall. Coronary angiography later confirmed a giant coronary aneurysm with a substantial thrombus. The combined presence of the coronary artery aneurysm and mitral valve prolapse in this patient was likely a sequela of Kawasaki disease. 相似文献
16.
彩色多普勒对正常人肠系膜上动脉的血流动力学研究 总被引:8,自引:1,他引:7
目的:测量正常人肠系膜上动脉(SMA)的血流参数。方法:应用彩色多普勒血流显像测量了100例健康人SMA的血流参数。结果:SMA直径(D)、血流量(Q)、血流速度、阻力指数(RI)、搏动指数(PI)、男女性别之间、年龄之间无明显差异。结论:提出了正常人SMA血流参数的正常值范围 相似文献
17.
Suat Fitoz Mesiha Ekim Zeynep Birsin Ozcakar Atilla Halil Elhan Fatos Yalcinkaya 《Journal of ultrasound in medicine》2007,26(5):573-580
OBJECTIVE: The purpose of this study was to evaluate the pathophysiologic characteristics of nutcracker syndrome (NS) and to assess the role of upright position imaging and superior mesenteric artery (SMA) angle measurement in the diagnosis. METHODS: Doppler sonographic findings in 23 children with NS and in 26 healthy control subjects were compared. The mesenteric angle, peak velocity (PV), and anteroposterior diameter of the left renal vein (LRV) at the hilar and aortomesenteric portions were measured in both the supine and upright positions. The means +/- SD of the SMA angle, anteroposterior diameter, and PV ratio between the two portions were calculated, and cutoff levels for the diagnosis of NS were established. RESULTS: The diameter and PV ratios were significantly different between the patient and control groups in both the supine and upright positions (P < .001). Differences between the supine and upright positions were also significant for the diameter of the LRV at the aortomesenteric portion, diameter ratio, and SMA angle in both groups. Upright position imaging revealed comparatively narrower SMA angles and more pronounced entrapment findings in patients with NS. The SMA angle measurement had sensitivity and specificity of 69.6% and 61.5%, respectively, in the supine position and 87.0% and 76.9% in the upright position when the cutoff values were set to less than 41 degrees and 21 degrees , respectively. CONCLUSIONS: The upright position has significant effects on the LRV hemodynamics and angle of the SMA in both patients and healthy subjects. Superior mesenteric artery angle measurement may be a useful adjunct parameter in the diagnosis of NS. 相似文献
18.
19.
Yuan-li Lei Wen-xing Song Yi Lin Hui-ping Li He-ping Lyu Jiao-zhen Chen Zhang-ping Li Jia-na Yin Ji-ke Xue Shou-quan Chen 《世界急诊医学杂志(英文)》2022,13(3):202
BACKGROUND:Spontaneous isolated superior mesenteric artery (SMA) dissection (SISMAD) is a rare cause of abdominal pain. The aim of the study is to investigate the role of a new parameter, the ratio of the SMA diameter to the superior mesenteric vein (SMV) diameter (SMA/SMV) based on non-enhanced computed tomography (CT), in the early diagnosis of SISMAD.METHODS:In a registry study from December 2013 to June 2021, 97 abdominal pain SISMAD patients (SISMAD group) admitted to our hospital were enrolled. Meanwhile, the matched sex and age abdominal pain non-SISMAD patients at 1:2 were collected in reverse chronological order as the control group. Student’s t-test, Wilcoxon rank-sum test, and Chi-square test were used to compare differences between the SISMAD and control groups. MedCalc was used to generate receiver operating characteristic (ROC) curve.RESULTS:A total of 291 abdominal pain patients, including 97 SISMAD patients and 194 non-SISMAD patients, were included in the current study. The maximum SMA diameter, perivascular exudation, and SMA/SMV based on non-enhanced CT were significant between the two groups (all P<0.05). ROC curves showed that for the maximum SMA diameter, the area under the curve (AUC), cut-off, sensitivity, and specificity were 0.926, 9.80, 93.8%, and 79.4%, respectively. For SMA/SMV, its AUC, cut-off, sensitivity, and specificity were 0.956, 0.83, 88.7%, and 92.3%, respectively. The diagnostic efficiency of SMA/SMV was better than that of the maximum SMA diameter (P<0.05). The combined parameters of SMA/SMV and maximum SMA diameter had the best diagnostic efficiency (AUC=0.970).CONCLUSION:SMA/SMV may be a potential marker for SISMAD. 相似文献
20.
Only scattered reports of portal vein and superior mesenteric vein aneurysms appear in the literature. Case reports of three
patients with portal vein and superior mesenteric vein aneurysms diagnosed by computed tomography (CT) and gray-scale, color
Doppler, and duplex Doppler sonography are presented. In one case, an isolated portal vein aneurysm was demonstrated. In the
second case, an aneurysm of the portal vein and superior mesenteric vein resulting in biliary ductal dilatation was observed.
In the third case, an isolated superior mesenteric vein aneurysm was found. None of the patients had a history or clinical
evidence of underlying liver disease, pancreatitis, or other disease states that would predispose them to the development
of aneurysms. The clinical presentations, possible etiologies, and imaging features of portal vein and superior mesenteric
vein aneurysms are reviewed. The value of CT and sonography in the detection and characterization of these rare aneurysms
is discussed.
Received: 29 February 1996/Accepted: 10 April 1996 相似文献