腹主动脉瘤腔内修复术后内漏与左肾周血肿的超声造影诊断特征

Diagnostic characteristics of contrast-enhanced ultrasound for endoleak and left perirenal hematoma after endovascular abdominal aortic aneurysm repair

目的探讨腹主动脉瘤腔内修复术后内漏与左肾周血肿的超声造影诊断特征。方法回顾性分析2022年5月6日空军特色医学中心心血管外科收治的1例腹主动脉瘤腔内修复术后内漏与左肾周血肿患者的临床资料,结合文献,总结超声造影在内漏诊断中的价值。结果患者男性,54岁,因“间断胸闷气短不适1年,加重1周”入院。2年前因发现腹主动脉瘤,行腹主动脉瘤腔内修复术,术后患者一般情况较差。常规超声示腹主动脉呈瘤样扩张,内可见支架回声,彩色多普勒示瘤体内红蓝相间的涡流信号;左肾肾周低回声包块,彩色多普勒示其内未见明显血流信号。超声造影示左肾周包块未见明显微泡进入,于腹主动脉支架上端左外侧壁周边可见微泡进入血管周边包块上半部内,并于右外侧壁返入支架内。超声提示:左肾周血肿,未见明显活动性出血;腹主动脉瘤支架术后,瘤体内可见活动性渗漏(Ⅰa型内漏)。腹部CT示动脉瘤处壁间血肿形成,腹膜后左肾后方包裹性积液(考虑为血肿),支架位置正常未见异常密度影。结论对于腹主动脉瘤腔内修复术后内漏患者,超声造影能实时观察术后的内漏部位,可弥补常规超声的缺点以及增强CT无法动态监测的不足,为内漏的诊断提供准确而有效的影像学依据。

Objective To explore the diagnostic characteristics of contrast-enhanced ultrasound for endoleak and left perirenal hematoma after endovascular repair of abdominal aortic aneurysm.Methods Retrospective analysis of the clinical information of a patient with endoleak and left perirenal hematoma following endovascular repair of abdominal aortic aneurysm at the Cardiovascular Surgery Department of the Air Force Medical Center on May 6,2022 was performed.The advantages of contrast-enhanced ultrasound in the diagnosis of endoleak were discussed,supported by relevant literature.Results A 54 year old male patient was admitted with complains of intermittent chest tightness,shortness of breath,and discomfort that had been present for 1 year and worsened for 1 week.Two years ago,the patient was found to have abdominal aortic aneurysm and underwent endovascular aneurysm repair.The general condition of the patient was poor after surgery.Conventional ultrasound showed aneurysmal dilatation of the abdominal aorta with stent echo,while color Doppler ultrasound showed red and blue vortex signals within the aneurysm.There was a hypoechoic mass in the left kidney,and color Doppler showed no obvious blood flow signal in it.Ultrasound contrast examination revealed that no obvious microbubbles entered the left perirenal mass.A microbubble entered the upper half of the perivascular mass around the left lateral wall at the upper end of the abdominal aortic stent and returned to the stent on the right lateral wall.Left perirenal hematoma detected on ultrasound,but no visible signs of ongoing bleeding.Active leakage(I a type endoleak)was visible in the tumor body following stenting for abdominal aortic aneurysm.Abdominal CT indicated the formation of an intramural hematoma at the aneurysm site,with encapsulated fluid accumulation in the left posterior kidney behind the peritoneum(considered a hematoma).The position of the sent was normal,and no abnormal density shadow was found.Conclusion For patients with endoleak after endovascular aneurysm repair,contrast-enhanced ultrasound can observe the endoleak site in real time,which makes up for the shortcomings of conventional ultrasound and the lack of dynamic monitoring of enhanced CT,and provides accurate and effective imaging basis for the diagnosis of endoleak.