不典型急性主动脉夹层3例报道及文献回顾

Three cases of acute aortic dissection with atypical presentations and literature review

急性主动脉夹层（acute aortic dissection,AAD）是一类可危及生命的急性主动脉综合征,主要见于60岁以上老年男性,其典型表现有：有长期、控制不良的高血压病史的患者突发、剧烈且持续的胸痛、背痛,疼痛呈撕裂样或刀割样,查体双侧血压不等、双侧脉搏强弱不等,影像学检查在主动脉内发现撕裂的内膜片即可诊断AAD。

Three cases presenting with atypical clinical and imaging presentations were summarized.The latest literature was reviewed to provide a comprehensive perspective on the clinical and imaging manifestations,treatment and prognosis.All three patients presented with severe and lasting chest pain of abrupt onset,and one of them accompanied with headache.Case 1,a 31-year-old woman visited for acute onset of chest pain,back pain and headache for 4 days,with no history of hypertension.Physical examination revealed pulse deficits.Echocardiography and CT aortography（CTA）confirmed the DeBakey Ⅰ type AAD.Case 2,a 40-year-old female presented for chest pain for 1 week,and reported no back pain.Physical examination revealed no pulse deficits.Echocardiography confirmed DeBakey Ⅱ type AAD.Case 3,a 38-year-old woman presented with severe chest pain and back pain of acute onset for 8 hours,and examination revealed pulse deficits.However,bedside transthoracic echocardiography failed to demonstrate the intimal flap or any abnormality in flow filling,while CTA confirmed AAD of DeBakey Ⅲ type.The diagnosis for AAD of atypical clinical and imaging manifestations warrants comprehensive evaluation of risk factors,symptoms,signs and imaging data.Echocardiography serves as a valuable noninvasive means for rapid and reliable evaluation,particularly for those involving the ascending aorta.