主动脉壁内血肿——一种不典型夹层的电子束CT诊断

目的:探讨主动脉壁内血肿(IMH)的电子束CT(EBCT)影像特征及对临床诊治的指导意义。方法:13例经EBCT连续容积增强扫描的主动脉IMH患者,综合分析其EBCT影像特征及临床特点。结果:EBCT所见IMH的直接征象:13例主动脉壁新月形或环形低密度增厚,无内膜片及真、假腔。7例血肿外缘轻度环状强化。血肿CT值60~108Hu。间接征象:穿透性溃疡征9例,钙化内移3例,主动脉壁粥样硬化8例,一侧或双侧胸腔积液7例(2例分别合并叶间裂或心包积液)。并发征象:动脉瘤2例,B型主动脉夹层1例。结论:EBCT是检出主动脉IMH的快速、无创检查方法,可清晰显示IMH的直接、间接征象及并发征象,对临床的诊治有重要的指导意义。     

真实稳态快速回波序列结合三维增强磁共振血管成像评价主动脉壁内血肿

目的 探讨真实稳态快速回波(true FISP)序列结合三维增强磁共振血管成像(3D CE-MRA)评价主动脉壁内血肿(IMH)的临床应用价值。方法 对38例IMH患者行true FISP序列扫描及3D CE-MRA,并进行MRI随访。依据随访结果将IMH患者分为稳定组及进展组,结合初诊及随访MRI对IMH的MR特征、自然史及预后进行分析。结果 38例IMH患者中稳定组25例,进展组13例。38例true FISP序列均可见新月形或环形主动脉壁增厚,且35例主动脉管腔与增厚管壁之间可见光滑的低信号环。Logistic回归分析显示心脑血管病是IMH早期进展的独立预测因素(P＝0.012)。以主动脉管壁厚度≥11 mm和最大径≥43 mm为阈值,预测IMH早期进展的敏感度和特异度分别为76.92%(10/13)、40.00%(10/25)和69.23%(9/13)、76.00%(19/25)。结论 true FISP序列结合3D CE-MRA有助于准确监测IMH的进展,并可为预后判断提供可靠的参考信息。     

急性主动脉综合征的诊治

急性主动脉综合征包括一类严重的、危及生命的主动脉疾病,包括急性主动脉夹层(aor t ic dissection,AD)、壁内血肿(intramural haematoma,IMH)、主动脉穿透性溃疡(penetrating aor tic ulcer,PAU),其中最常见的是主动脉夹层,其次为IMH、主动脉穿透性溃疡。先天性血管缺陷、遗传综合征和非遗传变异性综合征均是急性主动脉综合征的易患因素,可用CT、超声心动图、MR I等影像学方式来确诊。急性主动脉综合征的首要处理是控制血压以减少主动脉壁压力,其诊治往往需要一个多学科专家小组来评估并决定患者的治疗决策。急性主动脉综合征的最佳治疗方案仍然是一项具有挑战性的临床难题,需要进一步的研究来评价每种治疗方案的适用范围,制定以患者为本的精准治疗方案。     

血管内覆膜支架植入术治疗B型主动脉壁内血肿:术后MDCT随访

目的通过MDCT定期随访,评估血管内覆膜支架植入术(ESGT)治疗Stanford B型主动脉壁内血肿(IMH)的效果。方法回顾性分析接受ESGT治疗的17例B型IMH患者的资料。术后随访中,对所有患者行2次以上主动脉MDCT检查。结果 17例经ESGT治疗的B型IMH患者中,6例血肿完全吸收,9例明显吸收,2例血肿部分吸收。随访过程中无死亡病例,无并发症出现。结论 ESGT治疗B型IMH安全有效;MDCT可以作为重要的影像学随访方法。     

急性主动脉综合征的临床研究进展

急性主动脉综合征（acute aortic syndromes,AAS）是一组以急性发作为特征的主动脉疾病[1],很可能危及生命,包括主动脉夹层（AD）、主动脉壁内血肿（IMH）、主动脉穿透性溃疡（PAU）及外伤性主动脉损伤（TAI）。AAS以主动脉壁中膜撕裂为特点,伴或不伴内膜破口,其中血渗出将有助于夹层的进展（[2]）。血液可以局限在局部（如IMH）,     

多层螺旋CT血管成像诊断和随访主动脉壁内血肿及伴发病变

目的 探讨MSCTA在主动脉壁内血肿(IMH)及伴发病变的诊断及随访中的价值。方法 2006年5月-2012年12月,224例患者以急性主动脉综合征(AAS)或慢性病史就诊并接受主动脉MSCTA检查,其中37例诊断为IMH。分析IMH及其伴发病变的CT表现,并进行连续性定期随访。结果 37例IMH中,Stanford A型12例(12/37,32.43%),Stanford B型25例(25/37,67.57%);保守治疗21例,介入治疗10例,外科治疗6例。首次CT扫描IMH最大厚度6~27 mm,平均(12.3±4.9)mm,IMH处主动脉最宽外径32~73 mm,平均(40.7±7.6)mm。结论 MSCTA能够反映IMH及伴发病变的形态学特点,可作为诊断及治疗后随访的首选影像学方法。     

穿透性主动脉溃疡在主动脉壁间血肿中的作用进展

急性主动脉综合征是一组临床特点相近且以主动脉源性胸背痛和高血压为主要特点的疾病,包括主动脉夹层、穿透性主动脉溃疡(penetrating aortic uleer,PAU)和主动脉壁问血肿(aortic intramural hematoma,IMH).由于对PAU和IMH的认识不足,以往的观点认为这两种疾病是不典型的主动脉夹层(dissection of aorta,AD),临床上也将其以主动脉夹层来诊断和治疗.但是,由于影像学技术的发展,目前对这两种急性主动脉病变日益了解,其发病机制、临床特点、治疗及转归与主动脉夹层存在明显区别.而且处理不当极易发展成主动脉夹层[1-3].     

多层螺旋CT在急性主动脉综合征诊断中的应用价值

目的：探讨多层螺旋CT（MSCT）在急性主动脉综合征（AAS）的临床应用价值。方法：采用西门子Sensation16层螺旋CT扫描机,对59例主诉急性胸背痛患者进行MSCT检查。结果：59例患者中主动脉夹层（AD）40例,主动脉壁内血肿（IMH）11例,穿透性粥样硬化性溃疡（PAU）8例。MSCT能够显示三种疾病的特征性征象：AD可见内膜片和双腔征;IMH主动脉壁呈新月形或环形增厚≥5mm;PAU为凸出于主动脉管腔外的造影剂充盈的龛影。结论：MSCT是一种快速、无创的检查方法,能为AAS的诊断提供重要信息。     

脑脊液引流救治急性主动脉综合征引起的截瘫一例

正急性主动脉综合征(acute aortic syndrome,AAS)是一组严重威胁生命的主动脉性疾病,起病凶险、病死率高,发病24 h内,每1小时病死率增加1%~2%。AAS包括急性主动脉夹层(aortic dissection,AD)、壁间血肿(intra mural haematoma,IMH)和穿透性动脉粥样硬化性溃疡(penetrating aortic ulcer,PAU),均以动脉中层破坏为特征,其中以AD最为常见,其次为IMH。AAS最主要的临床表     

主动脉壁间血肿误诊为泌尿系结石原因分析

目的探讨主动脉壁间血肿(aortic intramural hematoma,IMH)临床特点及误诊原因。方法对我院收治的1例误诊为泌尿系结石IMH的临床资料进行回顾性分析,并复习相关文献。结果患者因左侧腹部疼痛伴腰部疼痛5 d,加重1 d入院。外院诊断为泌尿系结石,予相应治疗无效。入我院后2次查血浆D-二聚体和肌酸激酶均升高,高度怀疑主动脉夹层或撕裂,急行主动脉CT血管造影检查,确诊IMH,予控制血压、心率,降低左室收缩力及收缩速率,镇静、止痛等对症处理,病情缓解。结论临床表现不典型、诊断思维局限、缺乏诊断经验及未行特异性影像学检查是造成IMH误诊主要原因。     

Imaging features of intramural hematoma of the aorta

Intramural Hematoma (IMH) is defined as localized hemorrhage within the aortic wall and is included in the acute aortic syndrome spectrum with aortic dissection and penetrating aortic ulcer. The mortality from IMH is similar to classic aortic dissection (21%). 16% of patients with IMH will evolve to classic aortic dissection over time. Despite this confusion exists regarding the precise definitions and radiologic features of IMH versus penetrating ulcers with mural thrombus and overt aortic dissection.     

Where's the flap?

We present a case of aortic intramural hematoma (IMH) in an elderly woman who presented with sudden onset of mid-scapular pain. The patient underwent a series of multimodality imaging studies before the diagnosis of IMH was evident by cardiovascular magnetic resonance, which is rapidly becoming the gold standard in the evaluation of acute aortic disease due to its high spatial resolution and ability to characterize tissue composition. Early diagnosis and prompt treatment is critical in improving the outcome of patients with IMH.     

Clinical medical decision-making of acute aortic intramural hematoma: A non-randomized retrospective case study

ObjectiveThis study explored the timing of interventional treatment for acute intramural aortic hematoma (IMH) and the corresponding high-risk factors for its development into local aortic dissection (AD).MethodThis retrospective case study method examined clinical follow-up data of 42 patients with acute IMH between April 2013 and October 2016 from the First Affiliated Hospital of Xiʹan Jiaotong University. SPSS 17.0 and PPMS1.5 were used to analyze follow-up data spanning 3–12 months (mean, 7.5 ​± ​3.7 months).ResultsPatients were divided into the conversion group and the hematoma group according to whether they developed AD. Among them, 16 patients (38.1%) developed AD and were treated with thoracic endovascular aortic repair (TEVAR). The remaining patients (61.89%) were treated conservatively. After 1 week, the mean aortic diameter of the conversion versus hematoma group was significantly widened. Hemodynamically unstable patients and those with hematoma to the abdominal aorta extension were more likely to develop AD. Patient outcomes after TEVAR were similar between groups.ConclusionOur findings suggest that aortic isthmus diameter ≥3.0 ​cm, hematoma extending to the abdominal aorta, and hemodynamic instability are associated with AD development in acute IMH patents. TEVAR should be considered if hematoma thickening, calcification ingression, ulcer progression, or contrast enhancement within the intramural hematoma is noted beyond 2 weeks after IMH onset.     

Natural history of spontaneous aortic intramural hematoma progression: Six years follow-up with cardiovascular magnetic resonance

We described a 6 years follow-up of a spontaneous aortic intramural hematoma (IMH) with cardiovascular magnetic resonance (CMR) examination. Since multiple factors may play roles in the natural history of IMH, the patient experienced the course of progression, which included hematoma absorption, ulcer-like lesion, aneurysm and limited dissection. The initial and follow-up CMR examination included 3D CE MRA and non-enhanced "bright blood" pulse sequence. The inherent advantage of outstanding contrast with plain scan, which shorten the scan time and avoid potential risk of contrast agent, might make the fast gradient echo sequence as an alternative method when following stable IMH.