孤立性头臂动脉分支的超声心动图表现及漏误诊分析

Echocardiographic features of isolated brachiocephalic artery branches and analysis of missed diagnosis or misdiagnosis

目的:探讨孤立性头臂动脉分支的超声心动图特征,分析漏误诊原因,以提高超声心动图对孤立性头臂动脉分支畸形的诊断准确度。方法:回顾性分析2017年5月至2021年7月于河北省儿童医院经手术或CT血管造影(CTA)、数字减影血管造影(DSA)证实的孤立性锁骨下动脉、孤立性头臂动脉干患儿的超声心动图表现,复习PubMed检索到的其他罕见类型的孤立性头臂动脉分支的相关文献,归纳总结此类血管畸形的超声心动图特征。结果:共纳入4例孤立性头臂动脉分支患儿,超声心动图诊断正确孤立性头臂动脉干1例,漏误诊3例,其中漏诊孤立性锁骨下动脉1例,孤立性锁骨下动脉误诊为迷走锁骨下动脉1例,误诊为动脉导管未闭1例。文献回顾孤立性头臂动脉分支病例共105例,包含孤立性锁骨下动脉56例(53.3%)、孤立性头臂动脉干31例(29.5%)、孤立性颈总动脉15例(14.3%),孤立性颈内动脉3例(2.9%)。孤立性头臂动脉分支的超声心动图特征为主动脉弓头臂动脉分支与主动脉弓失去连接,常经动脉导管或直接连于肺动脉分叉处。结论:孤立性头臂动脉分支具有一定特征性超声心动图表现,该类血管畸形均伴有不同程度的窃血现象。仔细追踪头臂动脉分支的起源,必要时结合颈部血管超声可提高孤立性头臂动脉分支病变的诊断率。

Objective To explore the echocardiographic characteristics of isolated brachiocephalic artery branches,and to analyze the reason of missed diagnosis and misdiagnosis in order to improve the diagnostic accuracy.Methods Echocardiographic features of isolated subclavian artery and brachibrachial trunk confirmed by operation or CT angiography(CTA)or digital subtraction angiography(DSA)were retrospectively analyzed in Hebei Children′s Hospital from May 2017 to July 2021.Related literatures of other rare types of isolated brachiocephalic artery branches retrieved in PubMed were reviewed,and the echocardiographic characteristics of such vascular malformations were summarized.Results A total of 4 children with isolated brachiocephalic artery branches were included.Echocardiography correctly diagnosed isolated brachiocebrachial trunk in 1 case and missed or misdiagnosis in 3 cases,including isolated subclavian artery was missed in 1 case,isolated subclavian artery was misdiagnosed as aberrant subclavian artery in 1 case and patent ductus arteriosus in 1 case.A total of 105 cases of isolated brachiocephalic artery branches were reviewed,including isolated brachiocephalic artery in 31 cases(53.3%),isolated common carotid artery in 15 cases(29.5%),isolated common carotid artery in 15 cases(14.3%)and isolated internal carotid artery in 3 cases(2.9%).The characteristic of echocardiography was that the brachiocephalic branch of the aortic arch was disconnected from the aortic arch,often via the ductus arteriosus or directly connected to the bifurcation of the pulmonary artery.Conclusions Isolated brachiocephalic artery branches have certain characteristic echocardiographic features and these kinds of vascular malformations are accompanied by different degrees of stealing blood phenomenon.Careful tracing of the origin of brachiocephalic artery branches and combined with cervical vascular ultrasound when necessary can improve the diagnosis rate of isolated brachiocephalic artery branch lesions.