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超声诊断胸主动脉瘤和夹层剥离 |
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范 平 鲁树坤 周启昌 高 梅
摘 要
【目的】为评估多普勒超声检查诊断胸主动脉瘤或夹层剥离的价值。【方法】回顾分析经手术和心血管造影证实的超声资料较完整的胸主动瘤或夹层剥离20例，结合图像、病理及临床进行探讨。【结果】其中弓、降部真性动脉瘤7例(35%)，假性动脉瘤1例(5%)，升主动脉瘤7例(35%)，夹层剥离5例(25%)；超声误诊1例，诊断符合率95%。【结论】升主动脉瘤多为Marfan′s综合征，弓、降部主动脉瘤均为动脉粥样硬化所致，在夹层剥离中彩超对判断真假腔、寻找破口有独特的价值。
关键词 超声心动描记术，多普勒； 动脉瘤，胸； 动脉瘤，夹层； 动脉瘤，破裂
Diagnosis of Thoracic Aorta Aneurysm and Dissection by Ultrasonography
FAN Ping, LU Shukun, ZHOU Qichang,et al
Department of Ultrasonics,Second Affiliated Hospital,Hunan Medical University,Changsha,410011
Abstract
【Objective】To evaluate the role of Doppler ultrasonic examination in diagnosing thoracic aorta aneurysm and dissection.【Methods】Twenty cases of thoracic aorta aneurysm or dissection were diagnosed by ultrasonography and identified by surgery and cardiovasography.The images,pathological and clinical data were synthetically studied.【Results】Among 20 cases,there were 7 cases of aneurysm (35%) and one of pseudoaneurysm (5%) located on the arch and descending aorta,7 cases of aneurysm (35%) and 5 cases of dissection (25%) on the ascending aorta.One case was misdiagnosed.The diagnostic accuracy was 95%.【Conclusions】Ascending aorta aneurysms were usually seen in Marfan′s syndrome,while all aneurysms on the arch and descending aorta were caused by atherosclerosis.For patients suffering from dissection,color Doppler ultrasonography had special value in detection of true-false lumen and finding of break site on the endomebrane.
Key words echocardiography,doppler； aneurysm,thoracic; aneurysm,dissecting; aneurysm,repture
超声在腹部脏器中应用较广泛，有关胸主动脉瘤和夹层剥离的超声诊断报道甚少。以往其临床诊断较为困难，特别是对夹层剥离的诊断主要依赖于血管造影，且操作复杂，属创伤性检查，而超声检查简便、安全，同时可在床旁进行，是一种较好的无创伤性检查方法［1］。作者应用二维彩色多普勒超声诊断胸主动脉瘤和夹层剥离20例，现结合其超声图像、病理及临床特点以探讨其临床价值。
1 临床资料
1.1 一般资料 本组Marfan′s 综合征升主动脉瘤6例，均为男性，平均年龄30.1(21～40)岁，6例均并主动脉瓣关闭不全，5例合并二尖瓣脱垂，3例同时有关闭不全及心包积液。出现心血管症状2月至3年，6例活动后明显心悸、气促，4例发生心绞痛，具有典型Marfan&pri[1] [2] 下一页
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