【双语病例】主动脉穿通性溃疡1例CT影像表现

History

A 72-year-old man with one month of midabdominal pain that radiates to the back.

72岁男性,中腹部疼痛并向背部放射一月余。

【病例】主动脉穿通性溃疡1例CT影像表现

【病例】主动脉穿通性溃疡1例CT影像表现

【病例】主动脉穿通性溃疡1例CT影像表现

1.What is the most likely diagnosis?

Giant cell arteritis 巨细胞性动脉炎

Mycotic pseudoaneurysm 霉菌性假性动脉瘤

Penetrating atherosclerotic ulcer 主动脉穿通性溃疡

Ulcerated atherosclerotic plaque 动脉硬化斑块溃疡

【病例】主动脉穿通性溃疡1例CT影像表现

Additional Questions

2.This disease process typically occurs in the abdominal aorta.

该病一般发生于腹主动脉。

True

False

3.This lesion always involves disruption of the internal elastic lamina of the aortic wall.

病变多伴有主动脉壁内弹性膜破裂。

True

False

4.This lesion is most commonly infectious in etiology.

本病的病因一般为感染性病变所致。

True

False

5.Hematoma associated with this lesion is located in which of the following?

本病合并血肿一般发生在哪个部位?

Adventitia 动脉外膜

Intima 内膜

Lamina propria 固有层

Media 动脉中膜

【病例】主动脉穿通性溃疡1例CT影像表现

【病例】主动脉穿通性溃疡1例CT影像表现

选择题答案:

  1. Penetrating atherosclerotic ulcer

  2. False

  3. True

  4. False

  5. Media

【病例】主动脉穿通性溃疡1例CT影像表现

Findings and Diagnosis

Findings

CT demonstrates a focal, contrast-filled outpouching arising from the abdominal aorta just lateral to the origin of the superior mesenteric artery (SMA) extending beyond the normal confines of the aortic wall. The outpouching is surrounded by thrombus.

CT示:腹主动脉侧面、肠系膜上动脉旁可见一局限性凸起,内可见造影剂充盈,凸起周围被血栓包绕。

Differential Diagnosis

  • Mycotic pseudoaneurysm 霉菌性假性动脉瘤

  • Ulcerated atherosclerotic plaque 动脉硬化斑块溃疡

  • Penetrating atherosclerotic ulcer 穿通型溃疡

  • Abdominal aortic aneurysm 腹主动脉瘤

Diagnosis

Penetrating atherosclerotic ulcer

穿通性溃疡

【病例】主动脉穿通性溃疡1例CT影像表现

Key Points

Clinical Overview

  • Penetrating atherosclerotic ulcer (PAU) refers to an atheromatous plaque that ulcerates and disrupts the internal elastic lamina, extending through the intima into the aortic media.

    穿通性溃疡(PAU)是指动脉粥样硬化斑块溃疡、固有层破裂,穿破动脉内膜,突入中膜。

  • PAU is associated with hematoma formation within the media of the aortic wall.

    PAU一般合并主动脉中膜血肿形成。

  • PAU can break through into the adventitia to form a pseudoaneurysm or may rupture.

    PAU可突破动脉外膜形成假性动脉瘤、或可发生破裂。

  • Patients can present with chest, back, or abdominal pain; however, they may be asymptomatic.

    患者一般表现为胸痛、腹痛、或背痛,也可无明显症状。

  • Patients commonly have hypertension and hyperlipidemia.

    患者多有高血压或高血脂。

  • Persistent or recurrent pain, hemodynamic instability, and a rapidly expanding aortic diameter have been considered indications for endovascular or surgical treatment.

    疼痛持续存在或反复发作、血流动力学不稳定、或动脉直径迅速增加时,提示需要血管腔内修复术或手术治疗。

Imaging

  • Typically involve the descending thoracic aorta; however, they can also involve the abdominal aorta.

    PAU典型部位为升主动脉,也可发生于腹主动脉。

  • Often in the setting of extensive calcified atherosclerotic plaque.

    常发生于广泛钙化性动脉粥样硬化斑块形成的患者。

  • Focal, contrast-filled outpouching extending beyond aortic wall confines surrounded by an intramural hematoma (IMH) or thrombus.

    典型表现为主动脉壁局限性向外凸起,内可见造影剂充盈,凸起周围被壁间血肿(IMH)或血栓包绕。

  • Ulcer is often associated with thickening or enhancement of the aortic wall.

    溃疡多合并动脉壁增厚、强化。

  • IMH appears as concentric or crescentic aortic wall thickening.

    IMH表现为动脉壁环形或新月形增厚。

  • Atheromatous plaque with ulceration but without penetration through the intima shows irregular margins, but no contrast material extends beyond the level of intima and no intramural hematoma is present.

    动脉粥样硬化溃疡但尚未穿通内膜时,表现为动脉内壁不规则,但造影剂并未突破血管内膜,也无壁间血肿形成。

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