Mifune Yutaka, Yagi Masayoshi, Iwasaki Yasunobu, Doita Minoru
Department of Orthopaedic Surgery, Shin-Suma Hospital, Kobe 654-0047, Japan.
Case Rep Radiol. 2012;2012:127124. doi: 10.1155/2012/127124. Epub 2012 Jan 26.
A 74-year-old man developed a severe low back pain and a fever. In the initial examinations, a collapse of the L5 anterosuperior vertebral body and narrowing of the L4/5 disc space were identified on radiographs, and the laboratory data showed inflammatory results. A computed tomography (CT) and a magnetic resonance imaging showed collapse of L5. A needle biopsy was performed to make a diagnosis; however, an abdominal pain and a hypotension appeared after the biopsy. An abdominal CT showed a hematoma in the retroperitoneal space, and an angiography revealed a left fourth lumbar artery pseudoaneurysm. The pseudoaneurysm was treated with transcatheter placement of microcoils. Although haemorrhagic complications following needle biopsy are very rare, patients with large amounts of vertebral destruction may have unusual anatomical positions of the lumber artery. Therefore, surgeons should be aware of the possibility of lumbar artery injury during a needle biopsy and take care of prebiopsy plans.
一名74岁男性出现严重的下背部疼痛和发热。在初步检查中,X线片显示L5椎体前上缘塌陷以及L4/5椎间盘间隙变窄,实验室数据显示有炎症表现。计算机断层扫描(CT)和磁共振成像显示L5椎体塌陷。进行了针吸活检以明确诊断;然而,活检后出现腹痛和低血压。腹部CT显示腹膜后间隙有血肿,血管造影显示左第四腰动脉假性动脉瘤。通过经导管置入微线圈治疗假性动脉瘤。尽管针吸活检后的出血并发症非常罕见,但椎体大量破坏的患者可能存在腰动脉解剖位置异常。因此,外科医生在针吸活检过程中应意识到腰动脉损伤的可能性,并做好活检前的规划。