Paes E H, Vollmar J F
Dtsch Med Wochenschr. 1986 Dec 5;111(49):1881-7. doi: 10.1055/s-2008-1068729.
Initial manifestations of an abdominal aortic aneurysm may, depending on its site, morphology and direction of expansion, imitate numerous other intraabdominal diseases, but also lesions of peripheral vessels, vertebral column and spine. In this way they may give rise to errors of diagnosis and treatment. An abdominal aortic aneurysm should be considered especially in case of unclear gastrointestinal bleeding or abnormal intestinal passage (ischaemic colitis; mechanical displacement or compression of the duodenal-jejunal flexure and of the small-intestinal mesentery). In case of massive or recurrent gastrointestinal bleeding, especially in combination with a septicaemia, an aorto-intestinal fistula should be considered in the differential diagnosis. Radicular compression syndrome may be caused by an aortic aneurysm which is usually contained and predominantly suprarenal (to be considered especially once a herniated disk has been excluded by computed tomography). The same is true for unclear bone defects of the lumbar vertebrae (erosion by a penetrating aneurysm). Noninvasive methods, such as upper abdominal sonography, computed tomography and relatively minor invasive transvenous digital subtraction angiography now predominate in the definitive diagnosis of abdominal aortic aneurysm.
腹主动脉瘤的初始表现可能因其部位、形态及扩张方向不同，而酷似许多其他腹内疾病，也可能类似周围血管、脊柱及脊椎的病变。如此一来，就可能导致诊断和治疗失误。特别是在不明原因的胃肠道出血或肠道通过异常（缺血性结肠炎；十二指肠空肠曲及小肠系膜的机械性移位或受压）的情况下，应考虑腹主动脉瘤。在大量或反复胃肠道出血，尤其是合并败血症时，鉴别诊断应考虑主动脉肠瘘。神经根受压综合征可能由主动脉瘤引起，这种主动脉瘤通常局限，且多位于肾上腺上方（尤其是在计算机断层扫描排除椎间盘突出后，更应考虑）。腰椎不明原因的骨质缺损（穿透性动脉瘤侵蚀）情况亦是如此。如今，上腹部超声、计算机断层扫描等非侵入性方法以及创伤较小的经静脉数字减影血管造影在腹主动脉瘤的确诊中占主导地位。
