Williams David M, Cronin Paul, Dasika Narasimham, Upchurch Gilbert R, Patel Himanshu J, Deeb Michael G, Abrams Gerald
Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0326, USA.
J Vasc Interv Radiol. 2006 May;17(5):765-71. doi: 10.1097/01.RVI.0000209217.94558.81.
Small areas of blood flow are sometimes seen within an otherwise thrombosed false lumen on computed tomography (CT) scans of intramural hematomas of the aorta. These are blood-filled spaces that, although they have no apparent communication with the true lumen, appear isodense with the aorta on contrast-enhanced CT scans. The purpose of this report is to describe angiographic and autopsy studies that establish the nature of this entity and describe the principal CT features distinguishing it from a penetrating ulcer.
Conventional angiographic and CT aorta findings in two cases with small collections of contrast material within an otherwise thrombosed false lumen of an aortic dissection are discussed. Also examined is another case with pathologic and histologic findings in addition to those of small collections of contrast material within an otherwise thrombosed false lumen of an aortic dissection, which illustrate the pathoanatomy of these lesions.
Angiographic and necropsy evidence shows that some of these lesions represent branch artery pseudoaneurysms and, as such, are secondary to an intramural hematoma, not the primary cause of it.
Difficulty in demonstrating communication between these collections of contrast material and the adjacent true lumen of the aorta on helical CT examinations and the characteristic location of these lesions along the nonpleural portion of the aortic circumference distinguish them from penetrating ulcers and should suggest the diagnosis of branch artery pseudoaneurysm. Demonstration of a branch artery originating from the contrast collection confirms the diagnosis. These branch artery pseudoaneurysms should be distinguished from penetrating atherosclerotic ulcers.
在主动脉壁内血肿的计算机断层扫描（CT）图像上，有时会在原本血栓形成的假腔内看到小面积的血流区域。这些是充满血液的腔隙，尽管它们与真腔无明显连通，但在增强CT扫描上与主动脉呈等密度。本报告的目的是描述血管造影和尸检研究，以确定该实体的性质，并描述将其与穿透性溃疡区分开来的主要CT特征。
讨论了两例主动脉夹层原本血栓形成的假腔内有少量造影剂聚集的常规血管造影和CT主动脉检查结果。还检查了另一例除主动脉夹层原本血栓形成的假腔内有少量造影剂聚集外，还有病理和组织学检查结果的病例，这些结果说明了这些病变的病理解剖结构。
血管造影和尸检证据表明，其中一些病变代表分支动脉假性动脉瘤，因此是壁内血肿的继发病变，而非其主要病因。
在螺旋CT检查中难以显示这些造影剂聚集区与主动脉相邻真腔之间的连通，以及这些病变沿主动脉圆周非胸膜部分的特征性位置，将它们与穿透性溃疡区分开来，并提示分支动脉假性动脉瘤的诊断。显示起源于造影剂聚集区的分支动脉可确诊。这些分支动脉假性动脉瘤应与穿透性动脉粥样硬化溃疡相鉴别。
