多发性大动脉炎外周血管的超声诊断

目的 探讨多发性大动脉炎外周血管病变的超声表现。方法 采用美国GE公司生产的VIVID3彩色多普勒超声诊断仪。探头频率7.5MHz，对10例多发性大动脉炎患行二维及多普勒超声检查。结果 大动脉炎患受累血管分布为头臂动脉9例，其中锁骨下动脉9例，颈总动脉8例；腹主动脉5例，肾动脉3例，肺动脉1例，病变血管壁厚度2．0～5.0mm，管腔不同程度狭窄、闭塞及出现盗血现象。结论 超声诊断可较全面显示多发性大动脉炎形态学改变并可了解其血流动力学改变，应作为临床诊断多发性大动脉炎常规方法。     

Nontraumatic abdominal aortic thrombosis presenting with anterior spinal artery syndrome and pulmonary edema.

A 51-year-old woman with a history of breast cancer developed pulmonary edema and lower extremity paraplegia with preservation of proprioception as the initial manifestation of abdominal aortic thrombosis. Back pain was present in the lumbar region radiating to buttocks and legs in a bilateral radicular pattern. Femoral pulses were initially palpable. Aortic angiography revealed complete abdominal aortic occlusion at L3 as well as total occlusion of the bilateral superficial femoral arteries and bilateral common iliac arteries. Transient occlusion of the anterior spinal artery due to aortic thrombosis may cause paraplegia and may also progress to renal failure, bowel infarction, and limb loss if left untreated. Abdominal aortic thrombosis needs to be considered in a patient who presents with an anterior spinal artery syndrome, which, if present, must be treated as rapidly as possible to preserve motor and sensory function.     

彩色多普勒超声对多发性大动脉炎血管病变检查的价值

目的探讨多发性大动脉炎（Takayasu＇s arteritis，TA）彩色多普勒超声检查的诊断价值。方法22例多发性大动脉炎患者经彩超检查并经临床及血管造影确诊。结果1．大动脉炎最易累及颈动脉和锁骨下动脉；2.TA超声特征：血管壁节段性环状增厚，管腔狭窄或闭塞。结论彩超可以显示动脉管壁增厚这一主要的病理特征，在TA病变的检出、测量、分型及复查等方面有重要价值。     

Takayasu's arteritis. Carotid duplex sonographic appearance, including color Doppler imaging

Takayasu's arteritis (also known as pulseless disease, aortoarteritis, and aortic arch syndrome) is a chronic inflammatory arteriopathy that affects the aorta and its main branches as well as the pulmonary arteries. We report the carotid duplex sonographic findings of Takayasu's arteritis in three patients. Takayasu's arteritis can be suspected by noting a long segment of diffuse, homogeneous, circumferential vessel wall thickening in the proximal common carotid artery, resulting in narrowing of the lumen. The internal and external carotid arteries are normal.     

BILATERAL BREAST METASTASES FROM A RENAL CARCINOMA

SUMMARY Metastatic involvement of the breast is rare. The commonest cause is spread from a contralateral breast carcinoma. However, metastatic malignant melanoma, lymphoma and lung carcinoma have all been reported sporadically in the literature. Renal carcinoma is well recognised for its protean clinical manifestations ranging from loin pain, haematuria and an abdominal mass to less obvious metastatic effects such as pathological fracture of a long bone or one of a variety of associated paraneoplastic syndromes. We present a case of a renal carcinoma presenting with bilateral breast masses with literature review, and discuss the efficacy of the standard gamut of investigations in a breast mass of non-primary origin.     

胡桃夹综合征的诊治策略

胡桃夹综合征是指左肾静脉穿行于肠系膜上动脉与腹主动脉之间时受到两者的钳压,导致左肾静脉血液回流受阻而引起相应的临床症状。本文通过叙述胡桃夹综合征的发病机制、临床表现、影像检查、诊断以及治疗,使人们对胡桃夹综合征的研究趋势、动态、诊断及治疗水平有整体、客观的认识,从而熟悉本病,指导临床工作。     

Thrombolytic, antiplatelet and anticoagulant therapy for thrombotic disorders]

In the antithrombotic therapy, it's important to evaluate the role of thrombus in the present clinical status of thrombotic vascular diseases such as acute arterial occlusion, arteriosclerosis obliterans or deep vein thrombosis. For this purpose, coagulofibrinolytic immunochemical molecular markers such as thrombin-antithrombin III complex and D dimer may be useful. These markers are also useful for the evaluation of therapeutic effect. For the extremely severe ischemic limb, survey and treatment of transient atrial fibrillation and possible embolic source in heart, aorta or arteries are indispensable. Moreover, coagulation abnormalities (congenital antithrombin III, protein C, protein S deficiency or acquired anti-phospholipid syndrome) or basic immunologic disorders (Takayasu's arteritis, Beh?et disease or other autoimmune diseases) should be carefully excluded or properly controlled.     

Giant-cell arteritis

Giant-cell or temporal arteritis is a generalized vasculitis that predominantly affects large- and medium-sized arteries in people over 50 years of age. The illness is commonly characterized by the initial symptoms of headache, temporal artery tenderness or pulselessness, musculoskeletal pain, fever, and fatigue. The most dreaded consequence of giant-cell arteritis is visual loss, which is usually irreversible on presentation. Giant-cell arteritis may present with unusual clinical manifestations such as lip, scalp, and tongue necrosis, carpal tunnel syndrome, claudication of the limbs, strokes, angina pectoris, myocardial infarction, hematuria, cough, or other CNS symptoms. The etiology of the disease is unknown. Emergency physicians are usually familiar with the more common clinical symptoms but one must consider the unusual manifestations of the disease, because early recognition and initiation of therapy (steroids) decrease morbidity and can prevent blindness.     

Renal cell carcinoma associated with sarcoidlike tissue reaction

A 60-year-old man was referred to our institution with the diagnosis of sarcoidosis. Because of several months' complaint of right flank pain and weight loss, the patient had consulted his local physician. After an extensive workup revealed only cholelithiasis, he underwent a cholecystectomy for presumed chronic cholecystitis. At the time of operation, biopsy of several liver nodules and peripancreatic nodes revealed noncaseating granulomas, consistent with sarcoidosis. On initial examination at our institution, the patient had microhematuria. A chest roentgenogram demonstrated multiple pulmonary nodules, an abdominal computed tomographic scan showed an indeterminate left renal mass, and magnetic resonance imaging of the spine revealed abnormal signals in the body of T-12. Open-lung biopsy showed an adenocarcinoma with clear cell features, likely of renal origin. The patient was diagnosed as having a metastatic renal carcinoma associated with a sarcoidlike tissue reaction. Although noncaseating granulomas have been reported in association with other malignant lesions, to our knowledge this is the first report of such an association with renal carcinoma. In addition, this case illustrates several points. First, sarcoidosis is a multisystem disorder with protean extrapulmonary manifestations. In fact, all our patient's findings could have been attributed to sarcoidosis. Second, noncaseating granulomas occur with many types of processes, including infections, chemical exposures, and, as in this case, neoplasms. Thus, noncaseating granulomas are not pathognomonic for sarcoidosis. Third, sarcoidosis is a clinical diagnosis that cannot be based on histologic findings alone.     

大动脉炎肺动脉受累的常规超声与超声造影表现

目的探讨大动脉炎肺动脉受累的常规超声及超声造影特点及在疾病诊断中的价值。 方法回顾分析5例大动脉炎肺动脉受累患者的超声心动图、外周血管超声及心脏和外周血管超声造影的表现。 结果5例患者中主要的常规超声表现：三尖瓣反流（4/5）、肺动脉瓣反流（2/5）、肺动脉高压（3/5）、左或右肺动脉主干管腔细小（3/5）、左或右肺动脉主干管壁增厚回声减低（3/5）,肺动脉以外的外周动脉受累（5/5）;超声造影表现：左或右肺动脉主干管腔呈低或无增强（4/4）,外周动脉增厚管壁明显增强或少量增强（4/5）,无增强（1/5）。 结论大动脉炎肺动脉受累的超声表现有其特征性,肺动脉的常规超声和超声造影检查结合临床表现及外周动脉的病变情况将有助于明确诊断。     

Carotid lesions detected by B-mode ultrasonography in Takayasu's arteritis: "macaroni sign" as an indicator of the disease.

Twenty-three patients were studied to evaluate the clinical usefulness of high resolution B-mode ultrasonography in the detection of carotid lesions in patients with Takayasu's arteritis. In each patient the carotid arteries were examined using both B-mode ultrasonography (midfrequency of 7.5 MHz) and contrast angiography. In 19 of 23 patients, B-mode ultrasonography clearly demonstrated the characteristic circumferential arterial wall thickening of either one or both sides of the common carotid arteries as a macaroni-like, diffusely thickened intima-media complex. Conversely, contrast angiography demonstrated carotid lesions in only 13 of 23 patients. These results clearly show that B-mode ultrasonography is quite sensitive and superior in the detection of the characteristic thick intima-media complex of the common carotid artery in patients with Takayasu's arteritis, when compared with contrast angiography that is usually used for the definitive diagnosis of this disease.     

Polymyalgia rheumatica and giant cell arteritis

Polymyalgia rheumatica and giant cell arteritis are common, closely related vasculitic conditions that almost exclusively occur in patients older than 50 years. They may be manifestations of the same underlying disease and often coexist. Patients with polymyalgia rheumatica usually present with acute onset of stiffness and pain in the shoulder and pelvic musculature, which may be accompanied by fever, malaise, and weight loss. If untreated, polymyalgia rheumatica may result in significant disability. Giant cell arteritis may manifest as visual loss or diplopia, abnormalities of the temporal artery such as tenderness or decreased pulsation, jaw claudication, and new-onset headaches. Erythrocyte sedimentation rate and temporal artery biopsy help make the diagnosis. Giant cell arteritis requires urgent diagnosis because without treatment it may lead to irreversible blindness. Patients with either condition also may have nonspecific symptoms. Corticosteroids are the mainstay of therapy for both conditions, with higher doses required for treatment of giant cell arteritis. Duration of corticosteroid therapy can be five years or longer before complete clinical remission is achieved. Monitoring for corticosteroid-associated side effects such as osteoporosis and diabetes, as well as for relapses and flare-ups, is key to chronic management. The prognosis for either condition, if treated, is good.     

Atrial natriuretic polypeptide (ANP) as protective agent of renal ischemia

The effect of atrial natriuretic polypeptide (ANP) on hemodynamics and renal function was evaluated after the reconstructive surgery of the left renal artery in a patient with renovascular hypertension secondary to Takayasu's arteritis. The reconstructive surgery was done using the femoral artery, since we were unable to obtain adequate vein segments to fit the renal artery. The femoral artery was reconstructed by her saphenous vein segments. After 30 min of the aortorenal bypass operation, alpha-human ANP (alpha-hANP) was infused intravenously for 10 min at a rate of 0.1 microgram/kg/min. Although total peripheral resistance was decreased by alpha-hANP infusion, blood pressure was not changed because of the increased cardiac output. Glomerular filtration rate was increased markedly with concomitant increase in urine volume and urinary excretions of sodium, potassium and phosphate. Fractional excretions of water and sodium were not changed, but fractional excretion of phosphate and potassium clearance were increased. Thus, the infusion of alpha-hANP markedly improved the renal function of the ischemic kidney by the reconstructive surgery of the renal artery, suggesting that alpha-hANP seems clinically applicable as a protective agent in renal ischemia at renovascular surgery as well as the renal transplantation.     

Giant cell arteritis associated with acute Q fever – A case report

Q fever is a worldwide spread zoonotic disease, caused by the gram-negative intracellular bacillus Coxiella burnetii. Apart from its most common manifestations, Q fever has been reported to occasionally mimic autoimmune diseases. We herein present a case of acute Q fever in a 69-year-old man, manifesting as prolonged fever with pneumonitis, in whom biopsy of the temporal artery revealed giant cell arteritis. Moreover, PCR testing of the biopsy specimen was positive for Coxiella burnetii, thus further supporting the possibly infectious etiology of some cases of biopsy proven giant cell arteritis, with implications for treatment.     

彩色多普勒超声对多发性大动脉炎的诊断与分析

目的应用彩色多普勒超声诊断多发性大动脉炎引起的外周动脉血管及心脏病变的超声表现进行分析。方法彩色多普勒超声诊断仪，常规检查外周血管及心脏。结果5例患中，2例头臂动脉型，其中1例合并心脏病变；1例腹主动脉型；1例股总动脉型；1例。肾动脉型。超声表现为病变血管内中膜增厚不均匀，管壁不同程度的狭窄，其中1例左房、左室扩大伴左心功能减低(EF42％)。结论大动脉炎累及最多的血管为锁骨下动脉及颈总动脉，其次为腹主动脉、肾动脉、股动脉，同时可累及心脏。     

影像学诊断胡桃夹综合征进展

胡桃夹综合征（NCS）是由于左肾静脉在腹主动脉和肠系膜上动脉之间受压而引起一系列临床症状的综合征,包括血尿、蛋白尿、侧腹痛、生殖静脉曲张等。影像学检查如多普勒超声、CTA、MRA、血管腔内超声（intravascular ultrasound,IVUS）及肾静脉造影对诊断NCS具有重要作用。本文对NCS的影像学表现和诊断标准进行综述。     

Aneurysm of the extracranial carotid artery with spontaneous echo contrast revealed by duplex sonography

A 56-year old male patient without cerebrovascular disease or risk factors presented with a painless, pulsatile right-sided cervical swelling. Ultrasonography showed a large aneurysm of the right common and internal carotid artery with homogeneous thickening of the vessel wall as well as a parietal thrombus and a dilation of the left common and internal carotid artery with markedly reduced blood flow velocities. In the enlarged lumen of the right internal carotid artery spontaneous echo contrast was apparent with slow, ineffective but orthograde blood flow motions. Ensuing diagnostic procedures revealed multiple aneurysms involving the aorta and its branches. Despite surgical removal of the aneurysm and glucocorticoid therapy, the patient died from a ruptured aneurysm of a coronary artery a few weeks later. Post-mortem examination showed panarteritis consistent with Takayasu's disease. Spontaneous echo contrast is a frequent echocardiographic finding in patients with atrial fibrillation and mitral stenosis, indicating decreased blood flow. This is associated with an increased risk of embolism. In our patient, spontaneous echo contrast indicated severely disturbed haemodynamics due to a large aneurysm of the carotid artery. In the rare case of multiple aneurysms, differential diagnosis should include dissections, infections, and connective tissue diseases. Takayasu's arteritis, however, should also be considered, which usually presents with stenoses, but may be associated with multiple aneurysms of the aorta or its branches. If the diagnostic criteria are present, immunosuppressive treatment should be initiated.     

Chronic Total Occlusion and Successful Drug-Eluting Stent Placement in Takayasu Arteritis–Induced Renal Artery Stenosis

Takayasu arteritis-induced renal artery stenosis (TARAS) is a condition rarely described in the literature. Although percutaneous transluminal angioplasty and stenting has been well-described in the treatment of atherosclerotic renal artery stenosis, its role has not been established in non-atherosclerotic TARAS. We report a case of a female, age 17 years, with Takayasu arteritis who presented to the hospital with seizures and hypertensive crisis. A renal angiogram showed chronic total occlusion (CTO) of the left renal artery. Renal angioplasty and stenting was successfully performed after multiple attempts to deliver a wire distal to the CTO. After sequential balloon predilation, a drug-eluting stent was deployed, resulting in full reperfusion of the kidney. The patient’s blood pressure improved dramatically, and patency of the stent was demonstrated with magnetic resonance angiography over 9 months after the procedure.     

Asymptomatic occlusion of the left main coronary artery by an aortic pseudoaneurysm

Extrinsic compression of the left main coronary artery is a rare cause of coronary ischemia. We describe a 35-year-old Asian woman with complete asymptomatic occlusion of the left main coronary artery by a large aortic pseudoaneurysm. She underwent repair of the pseudoaneurysm and coronary artery bypass grafting at the Mayo Clinic in Rochester, Minn. The differential diagnosis is discussed. Based on this patient's age and associated vascular lesions, we conclude that Takayasu arteritis was the most likely cause of her condition.     

超声诊断多发性大动脉炎外周动脉病变的价值

目的 探讨超声诊断多发性大动脉炎外周动脉血管病变的价值。方法 采用Aeuson 128 XP 10型彩色超声诊断仪，探头频率5．0～7．5MHz，对33例多发性大动脉炎患者外周血管进行二维超声及彩色多普勒超声检查，分析病变动脉的二维及彩色多普勒声像图指标。结果 33例大动脉炎患者受累血管分布为：颈总动脉21例，锁骨下动脉14例，腹主动脉5例，肾动脉11例，股动脉1例，髂外动脉1例。病变血管壁厚度2．0～5．2mm。管腔不同程度狭窄或闭塞并出现盗血现象。结论 超声检查可全面显示多发性大动脉炎形态学改变，并可了解其血流动力学改变，是诊断大动脉炎的有力手段，可作为临床诊断多发性大动脉炎的常规方法。