[目的]探讨肺动脉鞘血肿(HPS)在Stanford-A型主动脉夹层(AD)中的检出率及其CT表现,评估患者短期预后不良的危险因素.[方法]回顾性分析连续188例经CT诊断为急性Stanford A型AD的患者,分析CT图像并记录临床资料.[结果]18例患者合并HPS,检出率为9.6%.累及右侧肺动脉9例,累及左侧肺动脉2例,双侧受累7例;9例血肿(50%)进入肺内支气管血管束周围鞘(Ⅱ型),其中7例伴周围片状实变/磨玻璃影.首诊CT后30 d内11例患者(61.1%)死亡,其中7例(63.6%)为Ⅱ型HPS,未发现病变延伸与死亡率有关联(P=0.335);腹部分支血管受累在死亡组中7例(63.6%),存活组中0例,两组比较有统计学差异(P=0.01).[结论]急性Stan-ford-A型AD合并HPS不少见,腹部分支血管受累提示预后不良.%[Objective]To retrospectively investigate the incidence,computed tomography(CT)manifestations and consequences of hemorrhagic pulmonary sheath(HPS)in Stanford A aortic dissection(AD)patients.[Methods]Institu-tional review board approval and informed consents were obtained.CT aortic angiography images of 188 consecutive acute Stanford A aortic dissection patients(mean age,59 years;range:29-78 years;136 males,52 females)were reviewed. CT images were interpreted by two independent radiologists.Clinical records were reviewed for outcomes of patients up to 30 days after the initial CT scan.[Results]18(9.6%)out of 188 patients had HPS.Right pulmonary artery was involved in 9(50%),left pulmonary artery in 2(11.1%)and both in 7(38.9%)of the 18 patients respectively.HPS extending along bronchovascular sheaths(TypeⅡ)was identified in 9(50%)of 18 patients,and 7(77.8%)of them had alveolar opacity around the thickened bronchovascular sheath. Within 30 days of follow-up,61.1%(11/18)patients died and 38.9%(7/18)patients survived with absorption of HPS.TypeⅡHPS was more prevalent in death group(7/11,63.6%) than survival group(2/7,28.6%),but not statistically significant(P=0.335).Patients in death group were more likely to have abdominal visceral arteries involvement(7/11,63.6%)than patients in survival group(0/7,0%)(P=0.010).[Conclusion]HPS was not a rare complication in patients with Stanford A AD.Abdominal visceral arteries involvement in-dicated poor short-term outcome in this study.
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