BACKGROUND Primary mediastinal leiomyosarcomas are extremely rare.We report a case of leiomyosarcoma around the thoracic and abdominal aorta,mimicking an aortic hematoma,and discuss the diagnostic value of ultrasound....BACKGROUND Primary mediastinal leiomyosarcomas are extremely rare.We report a case of leiomyosarcoma around the thoracic and abdominal aorta,mimicking an aortic hematoma,and discuss the diagnostic value of ultrasound.CASE SUMMARY A 63-year-old female was hospitalized for abdominal pain.Initial computed tomography angiography revealed an enhanced mass around the lower thoracic and upper abdominal aorta.Aortic hematoma was strongly suspected,and stents were placed by interventional surgery.About 1 mo postoperatively,the patient was re-hospitalized because of progressive abdominal pain.Ultrasound showed that the mass had a heterogeneous echo.In contrast-enhanced ultrasound,the hyperechoic regions were filled with contrast medium after the aortic region was,indicating that the blood supply was abundant but had no direct connection with the aorta.There was no obvious contrast medium-filling in the hypoechoic area.These findings were similar to those of malignant tumors with liquefaction and necrosis.Positron emission tomography/computed tomography confirmed that the mass had a high metabolic signal similar to that of a malignant tumor.Leiomyosarcoma was confirmed by postoperative pathology.CONCLUSION Symptoms of mediastinal leiomyosarcoma surrounding the aorta may mimic aortic hematoma.Contrast-enhanced ultrasound can provide valuable and unique diagnostic clues.展开更多
Objective:This study explored the timing of interventional treatment for acute intramural aortic hematoma(IMH)and the corresponding high-risk factors for its development into local aortic dissection(AD).Method:This re...Objective:This study explored the timing of interventional treatment for acute intramural aortic hematoma(IMH)and the corresponding high-risk factors for its development into local aortic dissection(AD).Method:This retrospective case study method examined clinical follow-up data of 42 patients with acute IMH between April 2013 and October 2016 from the First Affiliated Hospital of Xi?an Jiaotong University.SPSS 17.0 and PPMS1.5 were used to analyze follow-up data spanning 3–12 months(mean,7.5?3.7 months).Results:Patients were divided into the conversion group and the hematoma group according to whether they developed AD.Among them,16 patients(38.1%)developed AD and were treated with thoracic endovascular aortic repair(TEVAR).The remaining patients(61.89%)were treated conservatively.After 1 week,the mean aortic diameter of the conversion versus hematoma group was significantly widened.Hemodynamically unstable patients and those with hematoma to the abdominal aorta extension were more likely to develop AD.Patient outcomes after TEVAR were similar between groups.Conclusion:Our findings suggest that aortic isthmus diameter!3.0 cm,hematoma extending to the abdominal aorta,and hemodynamic instability are associated with AD development in acute IMH patents.TEVAR should be considered if hematoma thickening,calcification ingression,ulcer progression,or contrast enhancement within the intramural hematoma is noted beyond 2 weeks after IMH onset.展开更多
Objectives To investigate the morphologic characteristics of intramural hematoma(IMH)on CT angiography(CTA),and evaluate the possible correlation of serum C-reactive protein(CRP)with morphologic characteristics of IMH...Objectives To investigate the morphologic characteristics of intramural hematoma(IMH)on CT angiography(CTA),and evaluate the possible correlation of serum C-reactive protein(CRP)with morphologic characteristics of IMH.Material and Methods Forty-two patients who were initially diagnosed as IMH by aortic CTA and also had serum CRP examination on the same day of CTA were enrolled in this retrospective study,including 30 males and 12 females,with the mean age of 61±14 years old.The volumetric CT data were retrospectively processed and analyzed on post-processing workstation.Based on the thickness of IMH and the length-area curve,the crosssectional area of true lumen and total vessel were measured,the hematoma-vessel ratio(HVR)was calculated.Imaging characteristics were compared between patients who had pathological elevated CRP(>0.8 mg/dl)and those did not.Spearman correlation analyses of CRP level and morphological characteristics of IMH were performed,and the receiver operating characteristic(ROC)curve was used to evaluate the diagnostic validity of CRP.Results Of all 42 IMH patients,the mean serum CRP was 3.94±4.71 mg/dl,and the mean HVR was 46.7%±14.2%.HVR in patients with elevated CRP was significantly higher than those with normal CRP(49.7%±15.0%vs.40.7%±10.5%,P=0.030).HVR was mildly correlated with CRP in all patients(r=0.48,P<0.001).CRP levels differed neither between patients with Stanford type A and B(P=0.207),nor between patients with and without intimal disruption(P=0.230).To discriminate HVR>47%(the mean value),the area under curve(AUC)were 0.700(95%CI:0.535-0.865)for CRP at a cutoff point of 3.55 mg/dl,with a sensitivity of 54.5%and a specificity of 90.0%.Conclusion CRP was mildly correlated with the severity of cross-sectional hematoma area of IMH,but not with Stanford types and the presence of intimal disruption.展开更多
Hemodynamic instability secondary to left atrial (LA) compression by an aortic aneurysm is a rare entity. We report?the case of a 43-year old woman with no previous diagnosis of congestive heart failure who was admitt...Hemodynamic instability secondary to left atrial (LA) compression by an aortic aneurysm is a rare entity. We report?the case of a 43-year old woman with no previous diagnosis of congestive heart failure who was admitted for an initial diagnosis of pulmonary embolism (PE) based on shortness of breath, hypotension and D-Dimers?elevation. The electrocardiogram and blood counts were within normal limits. The chest X-ray revealed widening of the mediastinum. Transthoracic echocardiography demonstrated LA compression by a large descending thoracic aortic aneurysm. Left and right ventricle systolic functions were preserved. Chest angiography showed LA and left pulmonary artery (LPA) compression by a descending aortic aneurysm and an intramural hematoma with no evidence of PE evidence. Emergency surgery could not be done because of her financial status. She was treated medically and was discharged 1?week later with significant improvement. However she remained hypotensive.展开更多
AIM To assess potential benefits of an additional unenhanced acquisition in computed tomography angiography(CTA) in patients with suspected acute aortic syndrome(AAS).METHODS A total of 103 aortic CTA(non-electrocardi...AIM To assess potential benefits of an additional unenhanced acquisition in computed tomography angiography(CTA) in patients with suspected acute aortic syndrome(AAS).METHODS A total of 103 aortic CTA(non-electrocardiography-gated, 128 slices) performed due to suspected AAS were retrospectively evaluated for acute aortic dissection(AAD), intramural hematoma(IMH), or penetrating aortic ulcer(PAU). Spiral CTA protocol consisted of an unenhanced acquisition and an arterial phase. If AAS was detected, a venous phase(delay, 90 s) was added. Images were evaluated for the presence and extent of AAD, IMH, PAU, and related complications. The diagnostic benefit of the unenhanced acquisition was evaluated concerning detection of IMH.RESULTS Fifty-six(30% women; mean age, 67 years; median, 68 years) of the screened individuals had AAD or IMH. A triphasic CT scan was conducted in 76.8%(n =43). 56% of the detected AAD were classified as Stanford type A, 44% as Stanford type B. 53.8% of the detected IMH were classified as Stanford type A, 46.2% as Stanford type B. There was no significant difference in the involvement of the ascending aorta between AAD and IMH(P = 1.0) or in the average age between AAD and IMH(P = 0.548), between Stanford type A and Stanford type B in general(P = 0.650) and between Stanford type A and Stanford type B within the entities of AAD and IMH(AAD: P = 0.785; IMH: P = 0.146). Only the unenhanced acquisitions showed a significant density difference between the adjacent lumen and the IMH(P = 0.035). Subadventitial hematoma involving the pulmonary trunk was present in 5 patients(16%) with Stanford A AAD. The difference between the median radiation exposure of a triphasic(2737 mGy*cm) compared to a biphasic CT scan(2135 mGy*cm) was not significant(P = 0.135).CONCLUSION IMH is a common and difficult to detect entity of AAS. An additional unenhanced acquisition within an aortic CTA protocol facilitates the detection of IMH.展开更多
文摘BACKGROUND Primary mediastinal leiomyosarcomas are extremely rare.We report a case of leiomyosarcoma around the thoracic and abdominal aorta,mimicking an aortic hematoma,and discuss the diagnostic value of ultrasound.CASE SUMMARY A 63-year-old female was hospitalized for abdominal pain.Initial computed tomography angiography revealed an enhanced mass around the lower thoracic and upper abdominal aorta.Aortic hematoma was strongly suspected,and stents were placed by interventional surgery.About 1 mo postoperatively,the patient was re-hospitalized because of progressive abdominal pain.Ultrasound showed that the mass had a heterogeneous echo.In contrast-enhanced ultrasound,the hyperechoic regions were filled with contrast medium after the aortic region was,indicating that the blood supply was abundant but had no direct connection with the aorta.There was no obvious contrast medium-filling in the hypoechoic area.These findings were similar to those of malignant tumors with liquefaction and necrosis.Positron emission tomography/computed tomography confirmed that the mass had a high metabolic signal similar to that of a malignant tumor.Leiomyosarcoma was confirmed by postoperative pathology.CONCLUSION Symptoms of mediastinal leiomyosarcoma surrounding the aorta may mimic aortic hematoma.Contrast-enhanced ultrasound can provide valuable and unique diagnostic clues.
文摘Objective:This study explored the timing of interventional treatment for acute intramural aortic hematoma(IMH)and the corresponding high-risk factors for its development into local aortic dissection(AD).Method:This retrospective case study method examined clinical follow-up data of 42 patients with acute IMH between April 2013 and October 2016 from the First Affiliated Hospital of Xi?an Jiaotong University.SPSS 17.0 and PPMS1.5 were used to analyze follow-up data spanning 3–12 months(mean,7.5?3.7 months).Results:Patients were divided into the conversion group and the hematoma group according to whether they developed AD.Among them,16 patients(38.1%)developed AD and were treated with thoracic endovascular aortic repair(TEVAR).The remaining patients(61.89%)were treated conservatively.After 1 week,the mean aortic diameter of the conversion versus hematoma group was significantly widened.Hemodynamically unstable patients and those with hematoma to the abdominal aorta extension were more likely to develop AD.Patient outcomes after TEVAR were similar between groups.Conclusion:Our findings suggest that aortic isthmus diameter!3.0 cm,hematoma extending to the abdominal aorta,and hemodynamic instability are associated with AD development in acute IMH patents.TEVAR should be considered if hematoma thickening,calcification ingression,ulcer progression,or contrast enhancement within the intramural hematoma is noted beyond 2 weeks after IMH onset.
基金Fund supported by the Clinical Research Supporting Fund of Chinese PLA General Hospital(2016FC-TSYS-1039)~~
文摘Objectives To investigate the morphologic characteristics of intramural hematoma(IMH)on CT angiography(CTA),and evaluate the possible correlation of serum C-reactive protein(CRP)with morphologic characteristics of IMH.Material and Methods Forty-two patients who were initially diagnosed as IMH by aortic CTA and also had serum CRP examination on the same day of CTA were enrolled in this retrospective study,including 30 males and 12 females,with the mean age of 61±14 years old.The volumetric CT data were retrospectively processed and analyzed on post-processing workstation.Based on the thickness of IMH and the length-area curve,the crosssectional area of true lumen and total vessel were measured,the hematoma-vessel ratio(HVR)was calculated.Imaging characteristics were compared between patients who had pathological elevated CRP(>0.8 mg/dl)and those did not.Spearman correlation analyses of CRP level and morphological characteristics of IMH were performed,and the receiver operating characteristic(ROC)curve was used to evaluate the diagnostic validity of CRP.Results Of all 42 IMH patients,the mean serum CRP was 3.94±4.71 mg/dl,and the mean HVR was 46.7%±14.2%.HVR in patients with elevated CRP was significantly higher than those with normal CRP(49.7%±15.0%vs.40.7%±10.5%,P=0.030).HVR was mildly correlated with CRP in all patients(r=0.48,P<0.001).CRP levels differed neither between patients with Stanford type A and B(P=0.207),nor between patients with and without intimal disruption(P=0.230).To discriminate HVR>47%(the mean value),the area under curve(AUC)were 0.700(95%CI:0.535-0.865)for CRP at a cutoff point of 3.55 mg/dl,with a sensitivity of 54.5%and a specificity of 90.0%.Conclusion CRP was mildly correlated with the severity of cross-sectional hematoma area of IMH,but not with Stanford types and the presence of intimal disruption.
文摘Hemodynamic instability secondary to left atrial (LA) compression by an aortic aneurysm is a rare entity. We report?the case of a 43-year old woman with no previous diagnosis of congestive heart failure who was admitted for an initial diagnosis of pulmonary embolism (PE) based on shortness of breath, hypotension and D-Dimers?elevation. The electrocardiogram and blood counts were within normal limits. The chest X-ray revealed widening of the mediastinum. Transthoracic echocardiography demonstrated LA compression by a large descending thoracic aortic aneurysm. Left and right ventricle systolic functions were preserved. Chest angiography showed LA and left pulmonary artery (LPA) compression by a descending aortic aneurysm and an intramural hematoma with no evidence of PE evidence. Emergency surgery could not be done because of her financial status. She was treated medically and was discharged 1?week later with significant improvement. However she remained hypotensive.
文摘AIM To assess potential benefits of an additional unenhanced acquisition in computed tomography angiography(CTA) in patients with suspected acute aortic syndrome(AAS).METHODS A total of 103 aortic CTA(non-electrocardiography-gated, 128 slices) performed due to suspected AAS were retrospectively evaluated for acute aortic dissection(AAD), intramural hematoma(IMH), or penetrating aortic ulcer(PAU). Spiral CTA protocol consisted of an unenhanced acquisition and an arterial phase. If AAS was detected, a venous phase(delay, 90 s) was added. Images were evaluated for the presence and extent of AAD, IMH, PAU, and related complications. The diagnostic benefit of the unenhanced acquisition was evaluated concerning detection of IMH.RESULTS Fifty-six(30% women; mean age, 67 years; median, 68 years) of the screened individuals had AAD or IMH. A triphasic CT scan was conducted in 76.8%(n =43). 56% of the detected AAD were classified as Stanford type A, 44% as Stanford type B. 53.8% of the detected IMH were classified as Stanford type A, 46.2% as Stanford type B. There was no significant difference in the involvement of the ascending aorta between AAD and IMH(P = 1.0) or in the average age between AAD and IMH(P = 0.548), between Stanford type A and Stanford type B in general(P = 0.650) and between Stanford type A and Stanford type B within the entities of AAD and IMH(AAD: P = 0.785; IMH: P = 0.146). Only the unenhanced acquisitions showed a significant density difference between the adjacent lumen and the IMH(P = 0.035). Subadventitial hematoma involving the pulmonary trunk was present in 5 patients(16%) with Stanford A AAD. The difference between the median radiation exposure of a triphasic(2737 mGy*cm) compared to a biphasic CT scan(2135 mGy*cm) was not significant(P = 0.135).CONCLUSION IMH is a common and difficult to detect entity of AAS. An additional unenhanced acquisition within an aortic CTA protocol facilitates the detection of IMH.
