主动脉窦瘤破裂的临床特点及X线诊断(附39例报告)

Radiological diagnosis and clinical feature of ruptured aortic sinus aneurysm.report of 39 cases

目的进一步提高X线平片对主动脉窦瘤破裂的诊断。方法39例主动脉窦瘤破裂病例,右冠窦瘤破裂29例,无冠窦瘤破裂10例。全部病例均摄心脏远达片及左前斜位或吞钡左侧位片。分析其临床特点及X线表现,并与手术所见对照。结果主动脉窦瘤破裂的主要X线表现为心脏普遍增大,破入右房病例的心脏增大较破入右室者明显。心型多为普大型和二尖瓣型。多数病例出现不同程度肺淤血,部分病例肺淤血并肺充血。结论X线平片心脏增大和肺血增多,结合临床胸痛、典型心脏杂音等体征,可提示主动脉窦瘤破裂诊断。

Objective To elevate the accuracy of plain chest radiography for diagnosing the ruptured aortic sinus aneurysm. Methods Thirty- nine patients with surgically proved ruptured aortic sinus aneurysm which comprised the right coronary sinus of valsalva ruptured aneurysm（ n = 29）and the noncoronary sinus of valsalva ruptured aneurysm（ n = 10）underwent the examinations of plain chest radiography in PA, LAO or LL projection, The radiologic findings of ruptured aortic sinus aneurysm in all patients were retrospectively analyzed and compared with surgical findings, Resnlts The common radiological findings in 39 cases were general enlargement of the heart, especially, that was more obvious in ruptured into the right atrium than in ruptured into the right ventricle, The shape of heart in most patients presented as a general enlargement pattern or mitral pattern. Most patients presented pulmonary passive congestion or associated with pulmonary congestion. Conclusion Combination with typical clinical symptoms and continuous heart murmur, enlargement of the heart with increased pulmonary vessels on plain chest radiography could be suggestive of rupture of aortic sinus aneurysm.