The Hyperattenuating Crescent Sign Is Not Necessarily a Sign of Impending Aortic Aneurysm Rupture.
The Hyperattenuating Crescent Sign Is Not Necessarily a Sign of Impending Aortic Aneurysm Rupture.
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超额新的新月符号不一定是即将发生主动脉瘤破裂的标志。
DOI：
10.1016/j.avsg.2021.10.043
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发表时间：
2022-05
影响因子：
1.5
通讯作者：
Jackson, Benjamin M.
中科院分区：
文献类型：
--
作者：
Stoecker, Jordan B.;Eddinger, Kevin C.;Pouch, Alison M.;Glaser, Julia D.;Foley, Paul J. Iii;Wang, Grace J.;Kalapatapu, Venkat R.;Jackson, Benjamin M.
“新月征”是主动脉瘤的附壁血栓或壁内CT上的高密度新月形区域。尽管以前认为它与动脉瘤不稳定或即将破裂有关，但文献主要基于对紧急修复动脉瘤的回顾性分析。我们努力更严格地评估孤立的“新月征”和即将发生的主动脉破裂风险之间的关系。通过查询单个健康系统PACS数据库的放射学报告来识别患者，并注意到新月征。纳入了2004年至2019年期间CT显示降胸、胸腹或腹主动脉瘤和“新月征”的成人患者，排除了成像显示主动脉破裂明确体征的患者。共识别出82例患者。动脉瘤尺寸为7.1 ± 2.0 cm。30例患者在首次入院期间接受了紧急或紧急修复（37%），19例患者在以后接受了择期修复（23%），33例患者由于患者选择或禁止性医学合并症而未接受干预（40%）。未接受干预的患者在死亡或失访前的中位随访时间为275天。在接受择期介入治疗的患者中，从就诊到修复的时间为6，968患者日，急性破裂事件为0（中位数为105天）。与接受紧急/紧急修复术的患者相比，接受择期修复术的患者的动脉瘤较小（6.2 ± 1.3 vs. 7.7 ± 2.1 cm，P = 0.008）。没有小于8 cm的动脉瘤破裂的外科候选人。有31例患者在出现“新月征”前2年内有既往轴向成像，平均动脉瘤生长率为0.85 ± 0.62 cm/6个月[中位数0.65，范围0-2.6]。与动脉瘤尺寸为5.5-6.5 cm的患者或动脉瘤尺寸大于6.5 cm的患者相比，动脉瘤尺寸小于5.5 cm的患者显示动脉瘤生长减少（0.12 vs 0.64 vs 1.16 cm/6个月，P=0.002）。发现孤立的放射学“新月征”，而没有其他明确的主动脉破裂体征（即，血胸、主动脉壁破裂、腹膜后出血）不一定是主动脉破裂即将发生的指标，但可能在动脉瘤快速生长的情况下发现。许多因素，包括其他相关的影像学表现，动脉瘤大小和生长速度，以及患者的病理学，应该指导这些患者的动脉瘤管理。我们发现，症状轻微、动脉瘤尺寸小于6.5 cm且无动脉瘤不稳定（如主动脉周围脂肪绞合）的进一步影像学表现的患者，在优化共病因素后，可通过择期干预成功治疗，且无不良结局证据。
The “crescent sign” is a hyperattenuating crescent-shaped region on CT within the mural thrombus or wall of an aortic aneurysm. Although it has previously been associated with aneurysm instability or impending rupture, the literature is largely based on retrospective analyses of urgently repaired aneurysms. We strove to more rigorously assess the association between an isolated “crescent sign” and risk of impending aortic rupture. Patients were identified by querying a single health system PACS database for radiology reports noting a crescent sign. Adult patients with a CT demonstrating a descending thoracic, thoracoabdominal, or abdominal aortic aneurysm and “crescent sign” between 2004 and 2019 were included, with exclusion of those showing definitive signs of aortic rupture on imaging. A total of 82 patients were identified. Aneurysm size was 7.1 ± 2.0 cm. Thirty patients had emergent or urgent repairs during their index admission (37%), 19 had elective repairs at a later date (23%), and 33 patients had no intervention due to either patient choice or prohibitive medical comorbidities (40%). Patients without intervention had a median follow up of 275 days before death or loss to follow up. In patients undergoing elective intervention, 6,968 patient-days elapsed between presentation and repair, with zero episodes of acute rupture (median 105 days). Patients undergoing elective repair had smaller aneurysms compared to those who underwent emergent/urgent repair (6.2 ± 1.3 vs. 7.7 ± 2.1 cm, P = 0.008). No surgical candidate with an aneurysm smaller than 8 cm ruptured. There were 31 patients with previous axial imaging within 2 years prior to presentation with a “crescent sign,” with mean aneurysm growth rate of 0.85 ± 0.62 cm per 6 months [median 0.65, range 0–2.6]. Those with aneurysms sized below 5.5 cm displayed decreased aneurysm growth compared to patients with aneurysm’s sized 5.5–6.5 cm or patients with aneurysms greater than 6.5 cm (0.12 vs. 0.64 vs. 1.16 cm per 6 months, P=0.002). The finding of an isolated radiographic “crescent sign” without other signs of definitive aortic rupture (i.e., hemothorax, aortic wall disruption, retroperitoneal bleeding) is not necessarily an indicator of impending aortic rupture, but may be found in the setting of rapid aneurysm growth. Many factors, including other associated radiographic findings, aneurysm size and growth rate, and patient symptomatology, should guide aneurysm management in these patients. We found that patients with minimal symptoms, aneurysm sizes below 6.5 cm, and no further imaging findings of aneurysm instability, such as periaortic fat stranding, can be successfully managed with elective intervention after optimization of comorbid factors with no evidence of adverse outcomes.
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