主动脉壁间血肿误诊为急性腹痛1例报告

Aortic intramural hematoma misdiagnosed as acute abdominal pain：a case report

在急性主动脉综合征中，主动脉壁间血肿（IMH）是潜在致命的急症之一。它的主要危险并发症是进展为主动脉夹层，导致主动脉破裂、形成主动脉瘤或者完全吸收，早期诊断和治疗至关重要。但是，并不是所有IMH患者都具有典型的临床表现，早期诊断困难，容易引起误诊。IMH仅以急性腹痛起病实属罕见，笔者报道了1例以急性腹痛起病的68岁老年男性患者，最初误诊为其他腹部疾病，后经影像学检查得以确诊。急诊医师对仅表现为急腹症的IMH肿应引起注意，以做到早期诊断和处理。

Aortic intramural hematoma （IMH） is a potentially fatal entity in the spectrum of acute aortic syndrome. It is prone to evolve into aortic dissection, and then followed by aortic rupture, aneurysm or absorption without further sequelae. So, prompt recognition and appropriate intervention are quite essential. However, not all aortic IMH presents typical symptoms, and early diagnosis may be hard and even missed. It is relatively rare for aortic IMH manifesting acute abdominal pain at the begining. In this paper, we reported a 68-year-old man presenting with acute abdominal pain as the early symptom of aortic IMH, which was not recognized immediately, and even misdiagnosed as some abdominal diseases. The disease was identified after radiological examination. Emergency physicians should pay attention to aortic IMH only presenting acute abdominal pain, so as to make early diagnosis and appropriate management.