Leriche综合征漏诊一例报告

Leriche syndrome missed diagnosis:a case report

Leriche综合征是腹主动脉末段至髂动脉段,因动脉炎或动脉粥样硬化后发生钙化、溃疡、血栓形成引起纤维斑块病变,使管腔狭窄或闭锁导致远端血运不足而引起的一种罕见疾病。本文报告一例69岁男性患者曾误诊为腰椎管狭窄症,行保守治疗5年无效。再次就诊MRI显示腰椎未见明显异常,转血管外科排除血管病变。双下肢血管超声检查显示未见异常,认为症状与血管病变相关性较小,建议再次骨科就诊,以排除腰椎病变。经仔细查阅腰椎MRI后发现L2椎体水平以下腹主动脉腔内信号强度不均匀性增加,行腹主动脉CTA检查示腹主动脉及髂总动脉硬化,并肾动脉开口水平以下腹主动脉及髂总动脉管腔狭窄及闭塞,诊断为Leriche综合征。

The study showed a case of missed diagnosis of Leriche syndrome.Patients with intermittent claudication were diagnosed as lumbar spinal stenosis by local hospital with lumbar MRI.When conservative treatment was ineffective,the patients were treated in our spine clinic.However,the lumbar MRI showed no significant stenosis,and arteriovenous ultrasound also showed no abnormality.Vascular surgeons believed that patient’s symptoms had little correlation with vascular lesions.After careful reading of lumbar spine MRI,we found that the signal intensity of abdominal aorta increased unevenly below L2 vertebral level.CTA examination of abdominal aorta revealed sclerosis of abdominal aorta and common iliac artery,stenosis and occlusion of abdominal aorta and common iliac artery lumen below the level of renal artery orifice.The patient was finally diagnosed as Leriche syndrome.