急性主动脉壁内血肿的早期诊断

Early diagnosis of acute aortic intramural hematoma

目的探讨急性主动脉壁内血肿(AIH)的临床特点及早期影像诊断方法,以期提高该疾病的早期诊断水平。方法回顾性分析21例急性AIH的临床资料。结果长期高血压是AIH的主要原因。临床症状、体征变化较大。剧烈胸痛为常见首发症状(18例),亦有隐痛或剧烈疼痛后缓解;伴休克表现但血压升高7例,呼吸困难3例,多伴神经系统症状,其中头晕10例,晕厥1例,二便失禁1例;消化道症状有恶心、呕吐4例,吞咽困难1例。体征:血压升高19例,血压下降2例;四肢血压、脉搏不对称2例;主动脉瓣区舒张期杂音3例。并发症:急性左心哀竭(3例)、心包积液(2例)、腹主动脉瘤(1例)、中量胸腔积液(3例)、肺部炎症(4例)、脑梗死(1例)。经胸超声心动图(TTE)、电子计算机断层(CT)和磁共振显像(MRI)各有其影像学特点,联合应用、早期检查可以早期明确诊断。本组死亡2例,分别为主动脉破裂、急性心包填塞及急性左心衰竭。结论 AIH临床表现多样、复杂,掌握其临床特点,早选择或联合TTE、MRI及CT检查,以便早期发现AIH,选择合理的治疗方案。

Objective To explore the clinical characteristics and early image diagnosis of acute aortic intramural hematoma （AIH） for elevating the early diagnostic level.Methods The clinical datas of 21 acute AIH patients admitted in our hospital from September 2002 to May 2010 were analyzed retrospectively.Results The leading cause of acute AIH was hypertension for a long duration.The clinical manifestations had heterogeneity.Chest pain was the most common first-attack symptom （18 cases）,and some patients complained vague pain or violent pain which remitted itself.The other symptoms included shock representations but with hypertension （7 cases）,dyspnea （3 cases）,nervous systemic symptoms including dizziness （10 cases）,syncope （1 case）,incontinence of defecation and urination （1 case）,digestive systemic symptoms including nausea and vomiting （4 cases）,dysphagia （1 case）.The signs included hypertension （19 cases）,lowered blood pressure （2 cases）,asymmetric blood pressure and pulse of limbs （2 cases）,diastolic murmur of aortic valve area （3 cases）,etc.Complications were as follows：acute left heart failure （3 cases）,pericardial effusion （2 cases）,abdominal aortic aneurysm （1 case）,medium-volume effusion of thoracic cavity （3 cases）,pulmonary inflammation （4 cases）,cerebral infarction （1 case）.Transthotacic echocardiography （TTE）,CT and MRI had each own specific imaging features and merit,and its combination use may help to make rapid diagnosis.Of 18 cases,2 cases died from aortic rapture causing acute pericardial tamponade and acute left heart failure,respectively.Conclusions The symptoms and physical signs of acute AIH have clinical heterogeneity.The key of early diagnosing acute AIH is to recognize its clinical characteristics and choose appropriate imaging examination as soon as possible.