Yamanaka Yumiko, Ishida Hideaki, Naganuma Hiroko, Komatsuda Tomoya, Miyazawa Hideaki, Miyauchi Takaharu, Takahashi Satoshi, Tozawa Tomoki, Enomoto Katsuhiko
Center of Diagnostic Ultrasound, Akita Red Cross Hospital, 222-1 Kamikitade, Saruta, Nawashirosawa, Akita, 010-1495, Japan.
Department of Gastroenterology, Yokote Municipal Hospital, Yokote, Japan.
J Med Ultrason (2001). 2018 Jul;45(3):515-523. doi: 10.1007/s10396-018-0858-1. Epub 2018 Jan 30.
Splenic artery pseudoaneurysm (SAPA) is a relatively infrequently encountered but clinically important vascular change, because it carries a high risk of rupture that warrants prompt treatment regardless of its size. Thus, sufficient knowledge is indispensable when seeing chronic pancreatitis patients or post-traumatic patients. Here, we report two such cases. The first case was a 52-year-old woman known to have chronic pancreatitis who presented with hematemesis and hemodynamic instability in which X-ray computed tomography (CT) and color Doppler sonography (CDS) had difficulty visualizing slow blood flow in SAPA, but superb microvascular imaging (SMI) clearly demonstrated the slow blood flow in SAPA, prompting our therapeutic decision to perform rapid embolization. The second case was a 51-year-old woman with post-traumatic SAPA in which 3D SMI enabled us to understand more clearly the topographic relationship between multiple SAPAs as compared with conventional US, leading to a decision to provide immediate surgical treatment. SMI was thought to provide a new insight into the US diagnosis of SAPA. When examining patients suspected of having a SAPA, SMI is an indispensable diagnostic tool at present.
脾动脉假性动脉瘤(SAPA)是一种相对少见但临床意义重大的血管病变,因为它具有较高的破裂风险,无论大小都需要及时治疗。因此,在诊治慢性胰腺炎患者或创伤后患者时,充分的认识必不可少。在此,我们报告两例这样的病例。第一例是一名52岁的女性,已知患有慢性胰腺炎,出现呕血和血流动力学不稳定,X线计算机断层扫描(CT)和彩色多普勒超声(CDS)难以显示脾动脉假性动脉瘤内的缓慢血流,但超微血管成像(SMI)清晰地显示了脾动脉假性动脉瘤内的缓慢血流,促使我们做出快速栓塞的治疗决定。第二例是一名51岁的女性,患有创伤后脾动脉假性动脉瘤,与传统超声相比,三维超微血管成像使我们能够更清楚地了解多个脾动脉假性动脉瘤之间的地形关系,从而决定立即进行手术治疗。超微血管成像被认为为脾动脉假性动脉瘤的超声诊断提供了新的见解。在检查疑似患有脾动脉假性动脉瘤的患者时,超微血管成像是目前不可或缺的诊断工具。