Segmental arterial mediolysis: a rare cause of abdominal pain masquerading as vasculitis.
Segmental arterial mediolysis: a rare cause of abdominal pain masquerading as vasculitis.
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节段性动脉中溶解症：一种罕见的腹部疼痛原因，伪装成血管炎。
DOI：
10.1093/rheumatology/keab326
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Paik,JulieJ
中科院分区：
文献类型：
--
作者：
Connolly,CaoilfhionnM;Yu,Alice;Seo,Philip;Paik,JulieJ
尊敬的编辑，我们介绍一名 39 岁男性的病例，患有急性腹痛、恶心和呕吐。一年前，他报告了类似的症状，当时他接受了腹部 CT 检查，结果显示肾梗塞。他过去的病史还因未经治疗的高血压以及经常使用烟草和大麻而引人注目。经检查，他表现良好，生命体征明显，血压为 170/80 mmHg，但除此之外没有发烧，血流动力学稳定。巩膜呈白色。他的末梢脉搏检查在正常范围内。皮肤检查未发现任何皮疹、静脉曲张或皮肤松弛。腹部检查发现轻度上腹压痛，无反跳痛或警戒感。他的其余检查没有异常。初步实验室检查显示有轻度白细胞增多（白细胞计数 11.45 × 109/l）。综合代谢组和血清脂肪酶均正常。 C反应蛋白在正常范围内（0.77毫克/分升），红细胞沉降率轻度升高（22毫米/小时）。腹部和骨盆 CT 血管造影显示急性双侧肾梗死，伴有肾动脉右上极圆周增厚、腹腔轴壁弥漫性增厚以及右髂总动脉梭形扩张。肠系膜动脉造影随后显示腹腔干夹层，肝总动脉有一个梭形动脉瘤，肠系膜上动脉和肾动脉的节段分支上有几个多灶性夹层和动脉瘤，呈“串珠”状外观（图1）。颈部 CT 血管造影显示颈动脉受累呈阴性。临床病史和血管造影结果强烈提示节段性动脉中线溶解（SAM）的诊断。
DEAR EDITOR, We present the case of a 39-year-old man with acute abdominal pain, nausea and vomiting. He reported similar symptoms 1year prior, at which time he underwent an abdominal CT that demonstrated renal infarcts. His past medical history was otherwise notable for untreated hypertension as well as active tobacco and cannabis use. On examination, he was well-appearing, with vital signs notable for blood pressure of 170/80 mmHg, but he was otherwise afebrile and haemodynamically stable. The sclera were white. His peripheral pulse examination was within normal limits. Skin examination did not demonstrate any rash, varicosities or skin laxity. Abdominal examination was notable for mild epigastric tenderness without rebound or guarding. The remainder of his examination was unremarkable.Initial laboratory investigations demonstrated a mild leucocytosis (white blood cell count 11.45 Â 109/l). A comprehensive metabolic panel and serum lipase were normal. C-reactive protein was within normal limits (0.77 mg/dl) with a mild elevation in erythrocyte sediment rate (22mm/h). CT angiography of the abdomen and pelvis demonstrated acute bilateral renal infarcts with circumferential thickening of the right upper pole of the renal arteries, diffuse wall thickening of the celiac axis and fusiform dilation of the right common iliac artery. Mesenteric arteriogram subsequently demonstrated celiac trunk dissection with a fusiform aneurysm of the common hepatic artery and several multifocal dissections and aneurysms throughout the segmental branches of the superior mesenteric and renal arteries with a ‘string of beads’ appearance (Fig. 1). CT angiography of the neck was negative for carotid involvement. The clinical history and angiographic findings were strongly suggestive of a diagnosis of segmental arterial mediolysis (SAM).