主动脉夹层破裂并肺动脉壁血肿的CTA表现及临床意义

摘要

Objective: To study the mechanism, CTA findings and clinical implications of pulmonary arterial wall hematoma secondary to ruptured aortic dissection. Methods: We studied 183 patients with nontraumatic aortic dissection from 2007 to 2010 in our hospital, diagnoses were confirmed by CT angiography. CTA findings, treatment modalities and clinical outcomes were retrospectively analyzed in three patients with pulmonary arterial wall hematoma secondary to ruptured aortic dissection. Results: These 3 patients presented with chest pain on admission. CTA findings included: the intimal tear located in the proximal portion of ascending aorta extending to thoracic-abdominal aorta in one case, aortic arch extending only to ascending aorta in the second case and in the distal portion of aortic arch involving thoracic-abdominal aorta in the third case. The size of tear was 0.9cm, 0.8cm and 0.4cm respectively. The hematoma located in the wall of pulmonary arterial trunk in one case, in the wall of pulmonary artery trunk and bilateral pulmonary arteries in one case, in the wall of pulmonary artery trunk with bilateral pulmonary arteries and alveloar bleeding occurred in one case. On follow-up, the patient who underwent surgery survived now, while the other patients with conservative management deceased within 48 hours in hospital. Conclusion: CTA not only establishes the diagnosis of aortic dissection, but also defines the existence and extension of pulmonary arterial hematoma from the ruptured aortic dissection. According to our data and literatures review, patient's age and the extension of pulmonary arterial hematoma are important factors which affect patient's prognosis.%目的:探讨主动脉夹层((AD)破裂并肺动脉壁血肿的发生机理、CTA表现及其临床价值.材料与方法:收集我院2007年3月～2010年7月行CTA检查并诊断为非外伤性AD病例183例,对其中AD破裂并肺动脉壁血肿及蔓延的3例病例CTA表现、临床治疗方式及效果进行回顾性分析.结果:3例患者临床均以胸骨后疼痛而就诊.年龄45～82岁.CTA检查表现:第一破口位于升主动脉近段累及胸腹主动脉1例、主动脉弓升主动脉侧累及升主动脉1例、主动脉弓降主动脉侧累及胸腹主动脉1例;破口直径大小分别为0.9cm、0.8cm、0.4cm;主肺动脉干壁血肿1例、主肺动脉干及左右肺动脉壁血肿1例、主肺动脉干及左右肺动脉壁血肿和肺泡出血1例.随访中,1例行手术治疗患者至今仍存活,另2例保守治疗患者均于入院48h内死亡.结论:CTA检查不但能明确AD的诊断,还能确定有无夹层破裂外穿并肺动脉壁血肿及蔓延.结合相关文献及本组随访结果,年龄因素与动脉夹层破裂致肺动脉壁血肿并延伸程度是影响患者预后的重要因素.