Cho T, Tokunaga S, Izubuchi R, Masuda M
Department of Cardiovascular Surgery, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
Department of Surgery, Yokohama City University, Yokohama, Japan.
EJVES Short Rep. 2016 Jan 22;30:1-3. doi: 10.1016/j.ejvssr.2015.12.001. eCollection 2016.
Therapeutic strategies for intramural hematoma (IMH) involving the ascending aorta remain controversial.
The patient was a 72 year old woman with a history of chest pain. Multidetector computed tomography (MDCT) showed an IMH involving the ascending aorta. Because virtual angioscopy revealed a punctate intimal tear in the ascending aorta, acute aortic dissection with an intimal tear and not IMH was diagnosed, and emergency surgery was performed. The post-operative course was uneventful.
Virtual angioscopy allows the vascular lumen to be examined minimally invasively on the basis of images reconstructed from MDCT data. Even if MDCT does not clearly show an intimal tear associated with aortic dissection in a general view, virtual angioscopy can show the exact location and size of the tear before surgery. Virtual angioscopy is very useful for distinguishing thrombosed-type acute aortic dissection without clear ulcer like projections from an IMH, which may facilitate therapeutic planning.
累及升主动脉的壁内血肿（IMH）的治疗策略仍存在争议。
该患者为一名72岁有胸痛病史的女性。多层螺旋计算机断层扫描（MDCT）显示升主动脉存在壁内血肿。由于虚拟血管镜检查显示升主动脉有一个点状内膜撕裂，因此诊断为伴有内膜撕裂的急性主动脉夹层而非壁内血肿，并进行了急诊手术。术后过程顺利。
虚拟血管镜检查能够基于从MDCT数据重建的图像对血管腔进行微创检查。即使MDCT在整体视图中未清晰显示与主动脉夹层相关的内膜撕裂，虚拟血管镜检查也能在手术前显示撕裂的确切位置和大小。虚拟血管镜检查对于区分没有清晰溃疡样突出的血栓形成型急性主动脉夹层与壁内血肿非常有用，这可能有助于治疗方案的制定。
