Borrero E, Queral L A
Department of Surgery, University of Maryland Medical System, University of Maryland School of Medicine, Baltimore 21201.
Ann Vasc Surg. 1988 Apr;2(2):145-9. doi: 10.1016/S0890-5096(06)60797-8.
From January 1977 through December 1986, 134 patients with symptomatic AAAs were examined in the emergency room; 24 patients (mean age 72.4 years) had an initial misdiagnosis of "nephrolithiasis." Ten patients had the correct diagnosis of a ruptured AAA established within five hours of the initial examination and were promptly taken to surgery. Fourteen patients had delay greater than five hours while extensive diagnostic evaluations were performed (intravenous pyelograms in 12, computerized tomographic scans in 7, ultrasonography in 6). All patients underwent emergency surgery and six patients operated upon within five hours of initial examination survived. All patients who had extensive diagnostic evaluation lasting more than five hours died. The only diagnostic procedure that definitively established a ruptured aneurysm in all cases was the CT scan. In patients with confusing physical and laboratory findings but in whom the diagnosis of a ruptured AAA is entertained, an emergency CT scan is recommended as the diagnostic procedure of choice.
1977年1月至1986年12月期间，134例有症状的腹主动脉瘤患者在急诊室接受检查；24例患者（平均年龄72.4岁）最初被误诊为“肾结石”。10例患者在初次检查后5小时内确诊为腹主动脉瘤破裂，并迅速接受手术。14例患者在进行广泛诊断评估时延误超过5小时（12例行静脉肾盂造影，7例行计算机断层扫描，6例行超声检查）。所有患者均接受急诊手术，初次检查后5小时内接受手术的6例患者存活。所有接受超过5小时广泛诊断评估的患者均死亡。唯一能在所有病例中明确诊断为动脉瘤破裂的诊断方法是CT扫描。对于体格检查和实验室检查结果令人困惑但怀疑腹主动脉瘤破裂的患者，建议首选急诊CT扫描作为诊断方法。
