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目的研究急性单纯主动脉壁内血肿(intramural aortic hematoma,IMH)的影像学表现及临床预后,总结其转归特点,为临床随访及治疗策略的选择提供依据。方法选择2014年6月至2015年6月北京安贞医院连续收治的60例单纯IMH患者,所有患者均进行规律随访,分析其影像学特点及预后,平均随访时间为(10.0±4.6)个月。结果随访期间,IMH合并出现壁间血池(intramural blood pools,IBP)11例(18.3%),溃疡样突起(ulcer-like projection,ULP)11例(18.3%),穿透性主动脉粥样硬化性溃疡(penetrating atherosclerotic aortic ulcer,PAU)4例(6.7%)。42例血肿可见明显吸收或完全吸收。31例预后良好,29例病变进展。29例病变进展的患者中,病变增大18例,主动脉破裂3例,瘤样扩张5例,夹层形成2例,肺栓塞1例;其中11例进行了腔内修复及外科手术干预。结论 IMH随访期间血肿大部分吸收,但多数患者会出现并发症,提示临床医生需要对IMH患者进行严格的影像学随访观察。
Objective To study the imaging findings and clinical prognosis of acute simple intramural aortic hematoma (IMH), and to summarize the characteristics of its prognosis, so as to provide basis for clinical follow-up and treatment strategy selection. Methods Sixty patients with simple IMH who were consecutively admitted from June 2014 to June 2015 in Beijing Anzhen Hospital were enrolled in this study. All patients were followed up regularly to analyze their imaging features and prognosis. The mean follow-up time was (10.0 ± 4.6) months . Results During follow-up, 11 cases (18.3%) had intramural blood pools (IBP), 11 cases (18.3%) had ulcer-like projection (ULP) 4 cases (6.7%) of penetrating atherosclerotic aortic ulcer (PAU). 42 cases of hematoma visible absorption or complete absorption. 31 cases of good prognosis, 29 cases of disease progression. Of the 29 patients with pathological changes, the lesions increased in 18 cases, aortic rupture in 3 cases, tumor-like expansion in 5 cases, dissection in 2 cases and pulmonary embolism in 1 case. Eleven cases underwent endovascular repair and surgical intervention. Conclusion Most hematomas were absorbed during follow-up of IMH, but most patients had complications, suggesting that clinicians need rigorous radiographic follow-up of patients with IMH.