Terborg C, Brodhun M, Joachimski F, Fitzek C, Witte O W, Isenmann S
Department of Neurology, University of Jena, Germany.
Ultraschall Med. 2007 Apr;28(2):216-8. doi: 10.1055/s-2007-962892. Epub 2007 Mar 15.
A 56-year old male patient without cerebrovascular disease or risk factors presented with a painless, pulsatile right-sided cervical swelling. Ultrasonography showed a large aneurysm of the right common and internal carotid artery with homogeneous thickening of the vessel wall as well as a parietal thrombus and a dilation of the left common and internal carotid artery with markedly reduced blood flow velocities. In the enlarged lumen of the right internal carotid artery spontaneous echo contrast was apparent with slow, ineffective but orthograde blood flow motions. Ensuing diagnostic procedures revealed multiple aneurysms involving the aorta and its branches. Despite surgical removal of the aneurysm and glucocorticoid therapy, the patient died from a ruptured aneurysm of a coronary artery a few weeks later. Post-mortem examination showed panarteritis consistent with Takayasu's disease. Spontaneous echo contrast is a frequent echocardiographic finding in patients with atrial fibrillation and mitral stenosis, indicating decreased blood flow. This is associated with an increased risk of embolism. In our patient, spontaneous echo contrast indicated severely disturbed haemodynamics due to a large aneurysm of the carotid artery. In the rare case of multiple aneurysms, differential diagnosis should include dissections, infections, and connective tissue diseases. Takayasu's arteritis, however, should also be considered, which usually presents with stenoses, but may be associated with multiple aneurysms of the aorta or its branches. If the diagnostic criteria are present, immunosuppressive treatment should be initiated.
一名56岁男性患者，无脑血管疾病或危险因素，出现右侧颈部无痛性搏动性肿胀。超声检查显示右侧颈总动脉和颈内动脉有一个大动脉瘤，血管壁均匀增厚，伴有壁内血栓形成，左侧颈总动脉和颈内动脉扩张，血流速度明显降低。在右侧颈内动脉扩大的管腔内可见自发回声增强，血流缓慢、低效但呈正向流动。随后的诊断程序显示主动脉及其分支有多个动脉瘤。尽管手术切除了动脉瘤并进行了糖皮质激素治疗，但患者在几周后死于冠状动脉动脉瘤破裂。尸检显示符合高安动脉炎的全动脉炎。自发回声增强是心房颤动和二尖瓣狭窄患者常见的超声心动图表现，提示血流减少。这与栓塞风险增加有关。在我们的患者中，自发回声增强表明由于颈动脉大动脉瘤导致血流动力学严重紊乱。在罕见的多发动脉瘤病例中，鉴别诊断应包括夹层、感染和结缔组织疾病。然而，也应考虑高安动脉炎，其通常表现为狭窄，但可能与主动脉或其分支的多发动脉瘤有关。如果存在诊断标准，应开始免疫抑制治疗。
