Rupture of an aneurysmal aortic diverticulum associated with coarctation and bicuspid aortic valve.
Rupture of an aneurysmal aortic diverticulum associated with coarctation and bicuspid aortic valve.
复制标题
与缩窄和二叶式主动脉瓣相关的动脉瘤性主动脉憩室破裂。
DOI：
10.1161/circulationaha.110.958355
复制
发表时间：
2011
期刊：
影响因子：
37.8
通讯作者：
R. Uberoi
中科院分区：
文献类型：
--
作者：
S. Westaby;W. Bradlow;J. Newton;B. Mahesh;X. Jin;J. Perkins;R. Uberoi
一名28岁的足球运动员在赛前热身时出现虚脱和左侧胸痛。颈部左侧也出现疼痛。他以前没有胸痛过。儿童时期曾出现心脏杂音，归因于肺动脉狭窄，但从未随访。初次检查时，患者出现水肿，主动脉区有收缩期杂音，左锁骨上窝有搏动性肿块（图1A）。双臂之间没有血压差，但感觉不到股动脉脉搏。胸部X线片（患者首次接受）显示左上纵隔增宽（图1B）。对比度增强计算机断层扫描显示主动脉瘤样憩室延伸至颈部，并形成正常大小的左锁骨下动脉（图1C）。血管壁明显增厚，造影前密度高，与壁内血肿一致。主动脉缩窄位于动脉瘤远端（图1C）。没有肋骨切口。
A 28-year-old soccer player presented with collapse and left-sided chest pain during a prematch warm-up. Pain was also present in the left side of the neck. He had not suffered from chest pain before. A cardiac murmur had been described in childhood and attributed to pulmonary stenosis but never followed up. On initial examination, he was hypotensive, with a systolic murmur in the aortic area and a pulsatile mass in the left supraclavicular fossa (Figure 1A). There was no blood pressure differential between arms, but the femoral pulses could not be felt. A chest radiograph (the first the patient had ever received) revealed widening of the left upper mediasti-num (Figure 1B). Contrast-enhanced computed tomography showed an aneurysmal diverticulum of the aorta that ex-tended into the neck and gave rise to a normal-sized left subclavian artery (Figure 1C). The wall was markedly thickened, with high attenuation before contrast, in keeping with an intramural hematoma. Coarctation of the aorta was iden-tified distal to the aneurysm (Figure 1C). There was no rib notching.