子宫假性动脉瘤误诊分析

Analysis of ultrasound misdiagnosis of uterine artery pseudoaneurysm

目的 探讨子宫假性动脉瘤(uterine artery pseudoaneurysm, UAP)超声特征并分析误诊原因。方法 回顾性选取2016年1月至2023年4月首都医科大学附属北京妇产医院UAP患者35例,收集其超声图像及临床资料,分析其误诊原因。结果 UAP灰阶超声呈肌层或同时累及宫腔及肌层的含有液性无回声区团块状病变,彩色多普勒超声可见一条或多条载瘤动脉血流射入假腔,频谱多普勒超声呈高速低阻血流;部分可伴发动静脉瘘(uterine arteriovenous fistula,UAVF),表现为与子宫静脉同方向的粗大血流,频谱呈与心动周期一致的搏动性频谱。UAP误诊率为71.4%(25/35),被误诊的疾病包括与滋养细胞相关疾病的富血供征象(12例)、UAVF(9例)、滋养细胞疾病(3例)、胚物残留(1例)。结论减少UAP误诊首先需提高对该病的认识,超声检查过程中要注意调节仪器的条件设置以获得更佳图像帮助诊断。

Objective To explore the ultrasounic characteristics of uterine artery pseudoaneurysm(UAP)and analyze the causes of misdiagnosis.Methods A total of 35 patients with UAP from January 2016 to April 2023 in Beijing Obstetrics and Gynecology Hospital,Capital Medical University were selected retrospectively,and their ultrasonic images and clinical data were collected to analyze the causes of misdiagnosis.Results UAP gray-scale ultrasound showed lumpy lesions involving myometrium or both uterine cavity and myometrium,and color Doppler ultrasound showed that one or more tumor-bearing arteries were injected into the false cavity,and spectral Doppler ultrasound showed high-speed and low-resistance blood flow.Some might coexist with uterine arteriovenous fistula(UAVF),which was characterized by thick blood flow in the same direction as the uterine vein,and the spectrum was pulsatile in line with the cardiac cycle.The misdiagnosis rate of UAP was 71.4%(25/35).The misdiagnosed diseases included ultrasonographic sign of trophoblast cell related diseases(12 cases),UAVF(nine cases),trophoblastic diseases(three cases)and retained products of conception(none case).Conclusions To reduce the misdiagnosis of UAP,the understanding of the disease should be improved,and adjusting the parameters of the instrument during the ultrasonic examination to obtain better images is helpful in the diagnosis.