外伤致主动脉弓降部假性动脉瘤1例

<正>临床资料:患者男性,43岁,因"车祸致胸部外伤1 d"于2012年8月3日收入院。患者因车祸当时出现一过性意识丧失,无大小便失禁,意识恢复后出现胸闷、气短、心悸及腹胀。行主动脉CTA示:主动脉弓降部假性动脉瘤。诊断:主动脉弓降部假性动脉瘤,胸部外伤;创伤性湿肺;多发肋骨骨折。采用腔内隔绝术(TEVAR)经股动脉降主动脉覆膜支架     

以吞咽困难为首发症状的胸主动脉假性动脉瘤一例

患者女,62岁,为1例少见的以吞咽困难为首发症状的胸主动脉假性动脉瘤患者。现详述其诊断和治疗过程,并比较各种诊断方法的利弊。建议当发现疑似食管黏膜下肿物时,最好先行CT检查,排除胸主动脉假性动脉瘤的风险,再行超声内镜或病理活检进行确诊。     

主动脉夹层动脉瘤破裂致心脏骤停一例

病例摘要 :患者 ,女 ,72岁 ,保定市民。主因剧烈胸痛、出汗 1小时入院。平时无发作性胸痛 ,一般情况尚好 ,生活自理。本次发病无明确诱因。入院查体 :血压 15 0 10 0ｍｍ Ｈｇ,下肢无浮肿 ,双肺呼吸音清晰 ,无干湿性罗音 ,心尖搏动不弥散 ,心音有力 ,各瓣膜区未闻及杂音 ,腹软无压痛。心电图大致正常 ,胸部Ｘ线透视未发现异常 ,心脏彩超示主动脉增宽明显 (直径 6ｃｍ) ,未发现夹层 ,心脏瓣膜、腔室均正常。心肌五酶及其常规化验无明显改变。住院后初步诊断为主动脉夹层动脉瘤 ,即给卧床休息、止痛、降压、吸氧等治疗 ,病情一度趋于平稳。但…     

感染性心内膜炎并发升主动脉假性动脉瘤一例

患男，14岁，因“发现‘心脏病’7年，发热7天”于2004年1月27日入院。患7年前因“黑矇”于当地医院诊为“先天性心脏病”，未予重视。7天前出现发热，体温高时达39．8℃，伴畏寒、寒战，在外院输液、抗感染等处理，体温仍波动，遂入院。体格检查：体温39．6℃，血压100／64mmHg(1mmHg=0．133kPa)，呼吸22次／min。神志清楚，呼吸略促，颈静脉无怒张，肝颈回流征(-)。两肺未闻及干湿性啰音。心界不大，心率125次／min，心律齐，胸骨右缘第2肋间、左缘第3肋间可闻及4／6级收缩期杂音，喷射样，未闻及心包摩擦音。腹软，肝脾未及，双下肢无水肿。额头、头顶、     

误诊为食管息肉的降主动脉假性动脉瘤一例

患者女,62岁,2003年3月无诱因出现进食后胸骨后不适,伴嗳气,我院胃镜检查发现:“食管距门齿28 cm处可见一1．0 cm×4．0 cm梭形隆起,表面光滑,中央无溃疡形成,有黏膜桥形成”。超声内镜提示“病变沿食管走形向下逐渐增粗,向腔内突出,边界无法探及,内部回声不均匀。起源似来源于黏膜层”,诊断为食管息肉,建议定期复查。此后患者多次复查胃镜,皆无明显变化,内镜下仍诊断食管息     

腔内覆膜支架植入治疗Stanford B型主动脉夹层动脉瘤17例

Stanford B型主动脉夹层动脉瘤急性期病死率约70％,传统手术治疗效果不理想。2003年3月～2005年1月,我科采用腔内覆膜支架植入术治疗Stanford B型主动脉夹层动脉瘤17例,疗效较好。现报告如下。临床资料：17例Stanford B型主动脉夹层动脉瘤患者中,男16例．女1例;年龄45～71岁,平均60．1岁;临床表现：胸背部疼痛16例（急性剧烈疼痛10例,轻微疼痛6例）,体检发现1例（3a前曾有剧烈胸背痛）。伴有下肢缺血症状13例,高血压16例,冠心病2例,肾功能不全1例。     

减速损伤致主动脉夹层和延迟性心肌梗死一例

患者男 ,3 7岁。驾驶吉普车不幸与迎面驶来的货车相撞 ,当即人事不省 ,被送到当地医院急救。急诊ＣＴ检查发现纵隔增宽 ,左侧胸腔大量积血 ,左髋关节粉碎性骨折。入院第 7天 ,在无任何诱因下 ,患者发生胸痛 ,随即突然出现心室颤动 ,经除颤复律 ,心电图检查发现胸前Ｖ1 ～Ｖ5导联ＳＴ段抬高 ,出现Ｑ波 ,心肌酶谱明显增高 ,ＣＫ 3 974Ｕ/Ｌ ,ＣＫ ＭＢ4 6 9Ｕ/Ｌ。心脏超声示心脏前壁无收缩 ,射血分数 3 6 %。因诊断不明 ,并且合并有血胸、纵隔血肿 ,未予溶栓剂治疗。心肌梗死发生后一周 ,转入本院进行心脏导管检查。冠状动脉造影显示左前降支…     

食管鱼骨嵌顿致主动脉出血死亡一例

患者女,73岁,因吞咽不畅,胸骨后疼痛1周急诊就诊。患者1周前进食时不慎误食鱼骨,当时曾大口吞食物试图将其咽下,此后感吞咽不畅,胸骨后不适。     

胆道镜协助诊治肝动脉假性动脉瘤破裂致胆道出血一例

患者男,45岁,5d前无明显诱因出现右下腹持续性绞痛,与体位无关,伴大汗、心悸,无恶心呕吐,无发热、寒战,无呕血、黑便,遂来我院急诊。     

UGCR联合UGTI治疗心导管术后假性动脉瘤2例报告

假性动脉瘤(PSA)是心导管术后较常见的血管并发症。近年来,我们采用超声引导压迫修复(UGCR)和超声引导下注射凝血酶栓塞(UGTI)联合治疗心导管术后PSA患者2例,均获成功。现报告如下。临床资料:本组2例均为男性,年龄分别为60、62岁。于心导管术后第2天出现PSA,部位均为右股总动脉(RCFA),大小分别为28 mm×16 mm、21 mm×17 mm,颈长度分别<3.0、<2.6 mm,单叶。临床表现为局部(穿刺部位)出现搏动性肿块,新出现血管杂音和(或)震颤。均经临床及彩色多普勒确诊。方法:采用Philips ATL 5000彩色多普勒超声诊断仪,探头频率2~5 MHz和5~12 …     

Postoperative pseudoaneurysm of the ascending aorta. Report of a case

Pseudoaneurysm of the ascending aorta is a rare complication after cardiac surgical procedures. This report illustrates a case of postsurgical pseudoaneurysm of the ascending aorta with ischemic clinical episodes due to compression of the right coronary artery. The patient underwent aortic and mitral valve replacement 6 years previously. The usefulness of echocardiography, computerized axial tomography and angiography is emphasized.     

Myocardial injury due to lightning strike--a case report

Lightning strike is a natural phenomenon with potentially devastating effects and represents one of the leading causes of cardiac arrest and death from environmental phenomena. Almost every organ system may be impaired as lightning passes through the human body taking the shortest pathways between the contact points. In this paper, the authors report a 38-year-old man who was injured by lightning, a typical example of ;;side splash,' and had transient electrocardiographic changes.     

Shoulder hemarthrosis due to a bleeding pseudoaneurysm

We describe a patient with advanced shoulder osteoarthritis who developed a spontaneous hemarthrosis due to a bleeding pseudoaneurysm. This rare cause of intra-articular hemorrhage is important to establish because specific treatment may offer relief and prevent further bleeding.     

A case of aortitis syndrome which presented coarctation of aorta due to intraluminal flap formation in the middle of the thoracic aorta

We present a rare case of aortitis syndrome associated with dilatation of aorta and coarctation-like effect due to the intraluminal flap formation originated from dissected wall of the aorta. A 31-year-old woman was admitted to our hospital complaining of shortness of breath, palpitation and cough. On admission, her physical status showed congestive heart failure and hypertension of upper extremities and hypotension of lower extremities. Bruits were audible over the neck, the anterior chest and the back. Serological studies showed active inflammation. Chest X-ray film showed upper mediastinal widening, cardiomegaly and pulmonary edema. Aortitis syndrome was strongly suggested by these clinical findings, so that prednisolone therapy was started on 3rd hospital day. Special examinations were performed several days later when inflammatory changes showed a tendency to improve. Chest CT scan, RI angiography and MRI studies showed an aneurysmal dilatation from the ascending aorta to the mid-thoracic aorta. Aortography demonstrated a flap at the terminal portion of this aneurysmal dilatation and grade II (Sellars) aortic regurgitation. There was a pressure difference of 80 mmHg between the parts abutting cranial and caudal sides of the flap. A surgical operation was, then, performed to correct the pressure difference. The dissected wall was extruded toward the aortic lumen creating a flap (2 cm in length). This flap was resected and an artificial graft was inserted. Histologically, the flap consisted of adventitia, media and intima.(ABSTRACT TRUNCATED AT 250 WORDS)     

GRAFT infection of thoracic aorta due to group C beta-hemolytic streptococcus--a case report

A fatal case of late-onset graft infection of the thoracic aorta due to group C beta-hemolytic streptococcus is described. A 37-year-old male patient, who had a history of total aortic arch replacement for acute aortic dissection 8 years before, was admitted to the department. He suffered from toxic shock syndrome, disseminated intravascular coagulation (DIC), and acute renal failure. Group C beta-hemolytic streptococcus was detected from his blood; however, echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI) failed to detect the focus of the infection. In spite of intensive care, including antibiotic therapy, artificial ventilation, and continuous hemodiafiltration, he died on the 18th day of hospitalization. Autopsy revealed that a small abscess was present at the proximal anastomotic segments of the patient's graft. A bite inflicted by his dog, 14 days before admission, was suspected to be the source of this bacterium. A rare case of graft infection of thoracic aorta in terms of causative organism, long period from graft replacement to graft infection, and site of infection is presented and discussed.