经导管栓塞左椎动脉巨大假性动脉瘤一例

患者 男,28岁。颈项部被刀破伤30min,流血不止,急诊入院。体检：Bp80/40mmHg,P135次/min。颈项左侧由枕骨隆突下3cm斜行至右耳屏伤口长约15cm,急行局部清创,缝轧颈外侧动脉止血,离断肌肉吻合顺利。术后1～3d伤口无异常,亦无红肿及疼痛。     

子宫动脉假性动脉瘤经导管栓塞治疗2例

子宫动脉假性动脉瘤(uterine artery pseudoaneurysm,UAP)是罕见的但危及生命的并发症[1].现报道2例经导管成功栓塞治疗UAP,并作简要讨论.临床资料例1:患者61岁,因“阴道流血15 d,腹痛1d”收入院,33年前曾因“宫外孕”行“右侧输卵管切除术”,绝经年龄55岁.子宫腔内超声提示:“子宫内混合性肿块(大小约130 mm×115 mm×110 mm),考虑肌瘤变性,不除外肿瘤”.盆腔MRI提示:“子宫体积增大,内见一团块状不规则混杂信号影,直径约13.1 cm,T1WI、T2WI呈混杂信号,边界欠清楚,结合带不完整,增强后病灶实性部分明显强化,考虑子宫恶性肉瘤”.     

经导管凝血酶栓塞治疗十二指肠巨大假性动脉瘤一例

患者男,75岁。无意间扪及上腹部包块伴压痛,经CT检查发现为腹腔占位(图1),疑为动脉瘤。为确定诊断,于2005年6月23日在局麻下经右股动脉穿刺插管,行腹腔动脉造影见十二指肠动脉巨大假性动脉瘤(图2),约4.6 cm×5.8 cm。有介入栓塞治疗指征。造影后即用导丝将导管导引至十二指肠动脉破口远端,用3 mm×3 cm金属弹簧圈2枚进行栓塞,阻止远端血流逆行入动脉瘤内,在栓塞假性动脉瘤近端十二指肠动脉时,用了2枚8 mm×5 cm金属弹簧圈栓塞,但因残     

股动脉假性动脉瘤弹簧栓子栓塞1例报告

男 ,35岁 ,右股内侧肿胀、疼痛 2月余。肿胀呈进行性加剧 ,伴局部搏动性疼痛。体检 :右大腿肿胀明显 ,以内侧为剧 ,局部皮肤表面无红肿 ,可触及明显搏动 ,压痛明显 ,并可闻及血管杂音 ,右下肢活动尚可 ,末梢血运及感觉正常 ,双下肢肌力正常 ,实验室检查无特殊。Ｂ超　沿右股深动脉向下可探及一 3 .6ｃｍ× 2 .8ｃｍ液性暗区 ,边界清晰、呈球形 ,内可见暗淡光点飘浮 ,并可探及彩色血流信号。液区上极可探及一破口处 ,该处可探及动脉血流频谱。ＤＳＡ　右股深动脉受压向内侧移位 ,主干中段分支可见一小漏口 ,造影剂由此外溢形成“梨形”滞留区…     

大脑后动脉假性动脉瘤栓塞治疗1例报告

大脑后动脉假性动脉瘤临床上非常少见,其病理学特点表现为多种原因造成动脉破裂出血形成血肿,血肿吸收后残留假腔所致。由于缺乏真正的动脉瘤壁结构,极易破裂出血,其死亡率及病残率较高。对此病做出早期诊断并选择正确的治疗方案对于挽救患者生命是非常重要的。我们于2004年6月收治1例,结合病史、头颅MRA和全脑数字减影血管成像(DSA)证实为左侧大脑后动脉P1段假性动脉瘤,经小片段蓝宝石可脱卸弹簧圈(SDC)栓塞术后治愈出院。     

左侧上颌窦内平滑肌肉瘤1例报告

患者　女 ,3 8岁。因左侧鼻阻、涕中带血半年 ,加重 1月 ,外院鼻腔新生物活检疑为肉瘤而入院。查双侧鼻腔通气不畅 ,左侧下鼻道见一肿物 ,表皮不光滑 ,来源于上颌窦自然窦口 ,左侧上颌窦内侧壁缺如 ,鼻道内少量脓性分泌物 ,左眼球稍突 ,左侧上颌窦区压痛明显 ,左侧面部无明显肿胀。CT轴、冠状位检查示 :左侧上颌窦内充满软组织影 ,CT值 2 4～ 46HU ,向周围呈膨胀浸润生长 ,窦壁骨质破坏 ,表现为上颌窦内、上、外侧壁部分缺如 ,变薄 ;肿物向内突入鼻腔并向后突入后鼻孔 ,向后外突入颞下窝致翼外肌肿胀 ,周围脂肪间隙消失 ,向上浸润眼眶内…     

经导管栓塞脑膜中动脉假性动脉瘤合并动静脉瘘一例

患者　女 ,32岁。因“车祸后头痛 ,鼻腔出血 2h”入院。入院第 10d患者述耳鸣 ,难以入眠。体检 :意识Ⅰ级 ,双侧瞳孔等大等圆 ,直接及间接对光反射阳性 ,左眼眶部瘀血、肿胀 ,神经系统体征未见异常。听诊左眼眶下、耳前可闻及收缩期血管杂音。心电图及胸片正常。头颅CT :左颞骨     

经导管栓塞术治疗急性重症胰腺炎并发假性动脉瘤

目的 评价经导管栓塞术治疗急性重症胰腺炎并发假性动脉瘤的价值。方法 7例急性重症胰腺炎并发腹部假性动脉瘤患者进行了腹部动脉造影及经导管栓塞治疗，观察假性动脉瘤出现的部位、术中及术后并发症、再出血情况及临床结果。结果 造影共发现假性动脉瘤7例，位于脾动脉5例、胃网膜右动脉1例和胃左动脉1例，3例动脉瘤见活动性出血征象。6例动脉瘤用弹簧圈栓塞载瘤动脉，出血立即停止，其中5例1次栓塞成功，1例经2次栓塞成功。3例再次出血，再出血时间为14～60d，1例再次造影发现脾动脉假性动脉瘤形成，弹簧圈栓塞后出血停止，2例再次造影均未见明显出血原因，死亡。1例用明胶海绵颗粒栓塞无效，3d后出血死亡。2例发生与插管和造影操作相关的并发症，1例为动脉破裂，1例为动脉内膜夹层。无严重术后并发症发生。结论 经导管栓塞术治疗急性重症胰腺炎并发假性动脉瘤是1种有效和相对安全的方法。     

经导管可脱性球囊栓塞治疗因导管所致的肺动脉假性动脉瘤

由于肺动脉导管术引起肺动脉穿孔为少见并发症,在应用尖端带球囊的血流引导导管(经查为Swan-Ganz氏导管,译者)实行术操作中仅占0.125%。其原因为导管尖端直接穿破动脉壁,球囊过度膨胀或偏心性膨胀以及球囊置于动脉分叉部。因该项操作所致的动脉破裂的死亡率高达50%,伴有肺动脉高压或凝血性疾病者则几乎达100%。作者报道了2例因肺动脉导管操作引起的肺动脉假性动脉瘤,用经导管可脱性球囊栓塞治疗成功的经验。2例均为女性,年龄分别为78和68岁,在进行肺动脉导管检查术中突然发生咯血及肺内大片阴影,经保守治疗后,造影证实为肺动脉假性动脉     

超声诊断外伤性上颌动脉假性动脉瘤1例

患者 女．22岁。左腮腺区逼刀刺伤后伤口不愈伴口角歪斜14天而入院。专科检查：左侧面颊部相当于咬肌前缘有一长约2．0cm的横形伤口，探达肌层，深部可见肉芽组织及一引流条，有少量淡红色液体渗出。左侧腮腺区明显高起，但不红，皮温不高，轻度压痛，表面有较明显的血管搏动，听诊可闻及血管杂音。二维超声检查：于左侧腮腺内可见一     

Transcatheter Embolization of Pulmonary Artery False Aneurysm Associated with Primary Pulmonary Hypertension

A 29-year-old woman with primary pulmonary hypertension presented with recurrent hemoptysis. Contrast-enhanced CT of the chest demonstrated the enhanced mass surrounded by consolidation related to parenchymal hemorrhage. Pulmonary angiography suggested that the mass was a pulmonary artery false aneurysm. After a microcatheter was superselectively inserted into the parent artery of the false aneurysm, the false aneurysm was successfully treated by transcatheter embolization with coils. Her hemoptysis has never recurred.     

Transcatheter Coil Embolization of Splenic Artery Aneurysm

The purpose of this study was to evaluate clinical results and technical problems of transcatheter coil embolization for splenic artery aneurysm. Subjects were 16 patients (8 men, 8 women; age range, 40-80 years) who underwent transcatheter embolization for splenic artery aneurysm (14 true aneurysms, 2 false aneurysms) at one of our hospitals during the period January 1997 through July 2005. Two aneurysms (12.5%) were diagnosed at the time of rupture. Multiple splenic aneurysms were found in seven patients. Aneurysms were classified by site as proximal (or strictly ostial) (n = 3), middle (n = 3), or hilar (n = 10). The indication for transcatheter arterial embolization was a false or true aneurysm 20 mm in diameter. Embolic materials were fibered coils and interlocking detachable coils. Embolization was performed by the isolation technique, the packing technique, or both. Technically, all aneurysms were devascularized without severe complications. Embolized aneurysms were 6–40 mm in diameter (mean, 25 mm). Overall, the primary technical success rate was 88% (14 of 16 patients). In the remaining 2 patients (12.5%), partial recanalization occurred, and re-embolization was performed. The secondary technical success rate was 100%. Seven (44%) of the 16 study patients suffered partial splenic infarction. Intrasplenic branching originating from the aneurysm was observed in five patients. We conclude that transcatheter coil embolization should be the initial treatment of choice for splenic artery aneurysm.     

上颌窦、筛窦异位脑膜瘤1例报告

脑膜瘤为常见的颅内脑外肿瘤。上颌窦、筛窦异位脑膜瘤较少见。我院遇到 1例 ,经手术及病理证实 ,现报告如下。患者 ,男 ,11岁。因右侧鼻腔反复出血 6月余 ,加重伴头昏痛 ,右眼球突出 1月来我院就诊。查体 :一般情况可 ,右眼向外上突出 ,眼球活动自如 ,右鼻中道见白色新生物 ,双侧鼻腔有脓涕 ,右上颌窦区轻压痛。副鼻窦ＣＴ平扫示 :右侧上颌窦、右中后组筛窦、右眼眶内后部及右鼻腔为一球形高密度影占据 ,密度不均 ,中央为软组织密度 ,壁完整、光滑 ,呈骨样密度 ,厚薄不均。最大层面测其大小约 4ｃｍ× 4ｃｍ ,基底与右侧上颌窦外侧壁附着 ,…     

升主动脉假性动脉瘤1例报告

升主动脉瘤中,假性动脉瘤并不多见,现经病理、手术证实1例,报告如下。1病例介绍患者女,35岁。2周前感冒,自服药物后好转,1周前着凉后,再次感冒伴高热,咳嗽、胸痛,在当地医院就诊诊断为胸膜炎,治疗后好转。3d前自感胸前区撕裂疼痛,不能忍受,伴心慌、气短,不能平卧,不能忍受体力活动。查体:发育正常,营养中等,表情痛苦,被动体位,心前区无隆起,心尖搏动不弥散,胸骨左缘2~3肋间可闻及2/6收缩期杂音。2影像学表现核磁共振:升主动脉与上腔静脉间右心房上方见一圆形厚壁,直径为5cm大小,内有流定信号的病灶,升主动脉与病灶间可见一直径约为1cm大小的…     

左上颌窦髓外浆细胞瘤1例

患者女,45岁,3月前无明显诱因出现左面颊部肿胀,无痛,近1月感疼痛,无面麻,溢泪,脓涕等.体检:左面颊部肿胀,压痛.     

Transcatheter Arterial Embolization for Large Pancreaticoduodenal Artery Aneurysm with Mechanically Detachable Coils

Large aneurysms (5.5 and 3.6 cm in diameter) arising from the inferior pancreaticoduodenal artery located just near the main superior mesenteric artery were incidentally diagnosed in two patients. Transcatheter arterial embolization, packing mechanically detachable coils and microcoils into the aneurysms, was performed while the inflated balloon catheter was placed near the neck of the aneurysms. The procedures were successfully performed and no aneurysmal rupture or bowel ischemia was noted during follow-up. Balloon-assisted transcatheter arterial embolization with mechanically detachable coils seems to be an effective and safe treatment for large inferior pancreaticoduodenal aneurysms.     

冠状动脉瘤合并肺动脉瘘1例报告

患者　男 ,66岁。胸闷、气短 ,间断发作 9年 ,症状逐渐加重 ,伴气短及胸前区压榨感 ,按冠心病、心绞痛治疗后症状缓解。彩色多普勒显示左心室功能下降。冠状动脉造影显示左主干管状扩张 ,左前降支发出对角支之后形成囊样改变 (图 1)。SCT三维血管成像显示肺动脉圆锥左前方大小约 18mm的类圆形瘤样扩张影 (图 2 ) ,瘤体与左冠状动脉前降支之间可见大量迂曲成团的动脉血管影 ,紧贴肺动脉干分布 ,并与左前降支相连 (图 3 )。瘤体与冠状动脉根部有一细小血管影 ,该血管末端直径约 1.3mm ,其右 (外 )侧有一较粗大右冠状动脉血管 ,可见与瘤体交…     

Recanalization of Splenic Artery Aneurysm After Transcatheter Arterial Embolization Using N-Butyl Cyanoacrylate

A 65-year-old woman who had been diagnosed as having microscopic polyangiitis developed sudden abdominal pain and entered a state of shock. Abdominal CT showed massive hemoperitoneum, and emergent angiography revealed a ruptured splenic artery aneurysm. After direct catheterization attempts failed due to tortuous vessels and angiospasm, transcatheter arterial embolization using an n-butyl cyanoacrylate (NBCA)-lipiodol mixture was successfully performed. Fifty days later, the patient developed sudden abdominal pain again. Repeated angiography demonstrated recanalization of the splenic artery and splenic artery aneurysm. This time, the recanalized aneurysm was embolized using metallic coils with the isolation method. Physicians should keep in mind that recanalization can occur after transcatheter arterial embolization using N-butyl cyanoacrylate, which has been used as a permanent embolic agent.