Itzchak Y, Rosenthal T, Adar R, Rubenstein Z J, Lieberman Y, Deutsch V
Am J Roentgenol Radium Ther Nucl Med. 1975 Nov;125(3):559-70. doi: 10.2214/ajr.125.3.559.
In a series of 24 cases of acute dissecting aneurysm of the aorta (not including Marfan's disease) the diagnosis was usually suspected on the basis of the clinical picture and plain chest roentgenograms. The most consistent clinical sign was severe pain. Absent pulses and a neurological deficit were each noted in only five patients. In many cases there was no correlation between the clinical picture and the type or the extent of the dissection. Widening of the aortic arch and obliteration of the aortic knob with displacement of the trachea to the right are the most common signs in plain chest roentgenograms. A barium swallow examination in these cases reveals an elongated compression and displacement of the esophagus by the aortic arch. Calcification in the area of the aortic arch is the exception rather than the rule in dissecting aneurysms. Angiography is essential for the definitive diagnosis of dissecting aneurysms. The diagnosis is based on the demonstration of two channels, either by the presence of a linear radiolucency separating the two lumens, or by differences in flow that present as delayed opacification or delayed washout. If only the true lumen is opacified, widening of the outer extraluminal border of the aorta or narrowing of the lumen indicates the presence of a dissection. Abnormal catheter recoil and position were helpful in only two cases, and are not informative when the false lumen is catheterized. Failure to visualize main aortic branches was not always due to involvement by the dissection. It can also be caused by reduced flow due to severe proximal compression of the main lumen. The exact location of the intimal tears is usually not demonstrated unless additional injections are made in the area assumed to contain the tear. If only the false lumen is opacified in the ascending aorta, this can be recognized by the demonstration of a blind end, by failure to visualize the sinuses of Valsalva, from flattening of the medial border of the opacified channel, and from delayed washout in the blind end.
在一系列24例急性主动脉夹层动脉瘤病例（不包括马凡氏综合征）中，通常根据临床表现和胸部X线平片怀疑诊断。最一致的临床体征是剧痛。仅5例患者出现脉搏消失和神经功能缺损。在许多病例中，临床表现与夹层的类型或范围之间没有相关性。主动脉弓增宽、主动脉结消失以及气管向右移位是胸部X线平片中最常见的征象。这些病例的食管吞钡检查显示主动脉弓对食管有拉长的压迫和移位。主动脉弓区域的钙化在夹层动脉瘤中是例外而非普遍规律。血管造影对于夹层动脉瘤的明确诊断至关重要。诊断基于显示两个通道，要么通过存在分隔两个腔的线性透光区，要么通过表现为延迟显影或延迟排空的血流差异。如果仅真腔显影，主动脉外腔外边界增宽或腔变窄表明存在夹层。异常的导管回缩和位置仅在2例中有所帮助，当导管进入假腔时则无诊断价值。未能显示主动脉主要分支并不总是由于夹层累及。也可能是由于主腔严重近端受压导致血流减少所致。除非在假定含有撕裂的区域进行额外注射，通常无法显示内膜撕裂的确切位置。如果升主动脉中仅假腔显影，可通过显示盲端、未能显示主动脉窦、显影通道内侧边界变平以及盲端延迟排空来识别。
