主动脉壁间血肿误诊为泌尿系结石原因分析

Cause Analysis of Aortic Intramural Hematoma Misdiagnosed as Urinary Calculus

目的探讨主动脉壁间血肿(aortic intramural hematoma,IMH)临床特点及误诊原因。方法对我院收治的1例误诊为泌尿系结石IMH的临床资料进行回顾性分析,并复习相关文献。结果患者因左侧腹部疼痛伴腰部疼痛5 d,加重1 d入院。外院诊断为泌尿系结石,予相应治疗无效。入我院后2次查血浆D-二聚体和肌酸激酶均升高,高度怀疑主动脉夹层或撕裂,急行主动脉CT血管造影检查,确诊IMH,予控制血压、心率,降低左室收缩力及收缩速率,镇静、止痛等对症处理,病情缓解。结论临床表现不典型、诊断思维局限、缺乏诊断经验及未行特异性影像学检查是造成IMH误诊主要原因。

Objective To investigate the clinical features and misdiagnosed causes of aortic intramural hematoma （IMH）. Methods Clinical data of one patient with IMH misdiagnosed as urinary calculus was retrospectively analyzed and pertinent literatures were reviewed. Results The patient was admitted for left abdomen and waist pain for 5 days and aggravation for 1 day. The patient was misdiagnosed as having urinary calculus and failed to response to correlative therapy in other hospitals. The patient~ blood plasma D-Di- mer and creatine kinase were elevatory, and the diagnosis of IMH was defined after computed tomography angiography （CTA） examina- tion immediately for considering dissection of aorta or dilaceration. The patient recovered after blood pressure control, reducing ventricu- lar rate, sedative and analgesic treatment. Conclusion Misdiagnosis may be attributed to non-representative clinical manifestations, lack of understanding of IHM, limited diagnostic thinking and lack of access to specificity imaging examination.