假性动脉瘤破裂死亡患者临床及影像特征

Clinical and Imaging Features of Death Patients with Pseudoaneurysm Rupture

目的探讨假性动脉瘤破裂死亡病例的临床特点和影像学特征,加强认知,提高预防策略和早期诊治意识。资料与方法回顾性分析2016年1月—2021年12月空军军医大学第二附属医院6例假性动脉瘤破裂死亡患者的临床、CT及MRI资料。结果假性动脉瘤CT及MRI表现为突出载瘤动脉的类圆形或不规则形瘤体,并可见破口与载瘤动脉相通,瘤体内可有血栓形成,邻近载瘤动脉可有受压移位、管腔变细或增粗等表现。影像学检查提示6例假性动脉瘤位置、形态、大小、破口大小、与载瘤动脉的关系以及与周围组织结构的关系显示清晰,诊断明确。2例均因误吞枣核、内镜下取出后主动脉弓部假性动脉瘤形成,病1例外伤、1例介入术后导致假性动脉瘤形成,1例病因不明,1例因颅内非特异性感染侵蚀邻近血管壁导致左侧颈内动脉海绵窦段假性动脉瘤形成。6例病例死亡前均有突发呕血或鼻出血症状,提示假性动脉瘤破裂。结论假性动脉瘤破裂死亡率高,CT及MRI可客观显示其影像学特征,具有一定的临床价值。

Purpose To explore the clinical and imaging characteristics of rupture death cases of pseudoaneurysm,and to enhance the awareness of prevention strategies,early diagnosis and treatment.Materials and Methods Clinical imaging data of six patients with pseudoaneurysm rupture and death in the Second Affiliated Hospital of Air Force Military Medical University from January 2016 to December 2021 were retrospectively analyzed.Results CT and MRI findings of false aneurysms were circular or irregular tumor bodies that protrusion the tumor bearing artery,and could be seen to communicate with the tumor bearing artery.There might be thrombosis in the tumor body,compression displacement of the adjacent tumor bearing artery,thinning or thickening of the lumen.Imaging features of six cases with pseudoaneurysm showed that the location,shape,size,size of rupture,relationship with parent artery and surrounding tissue structure,with clear and definite diagnosis.Two cases of pseudoaneurysm of aortic arch was formed after swallowing date kernel by mistake and removing under endoscope.Pseudoaneurysm formation was caused by trauma in one case,after intervention in one case,and with no clear reason in one case.In one case,pseudoaneurysm of cavernous segment of left internal carotid artery was caused by erosion of adjacent vessel wall by intracranial nonspecific infection.Before death,all 6 cases had sudden symptoms of hematemesis or nosebleed,suggesting pseudoaneurysm rupture.Conclusion The rupture of pseudoaneurysm has a high mortality rate.CT and MR can objectively show the imaging manifestations of pseudoaneurysm,with certain clinical value.