East Kent Hospital Trust, NHS England, Ashford, UK.
East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
BMJ Case Rep. 2024 Jun 27;17(6):e257411. doi: 10.1136/bcr-2023-257411.
A man in his 70s presented with a sudden onset stabbing back pain radiating to the chest and pre-syncopal symptoms. He underwent urgent investigations, including a CT angiogram aorta which did not reveal any abnormalities within the thorax, abdomen or pelvis and no cause of symptoms was identified. After being discharged, he re-presented 2 days later with syncopal episodes, abdominal pain and a significant drop in haemoglobin levels. This time, a CT mesenteric angiogram showed two hepatic artery pseudoaneurysms and a large haemoperitoneum. Following a hepatic artery embolisation, a workup showed that the likely cause of the pseudoaneurysms was a rare first presentation of polyarteritis nodosa. This case highlights the importance of considering the possibility of an aneurysmal rupture, especially when common causes of an acute abdomen have been excluded, and not relying on previous negative investigations to exclude pathology, as the outcomes can be detrimental.
一位 70 多岁的男性突发胸痛、前胸晕厥症状的刀割样背痛。他接受了紧急检查，包括主动脉 CT 血管造影，未发现胸部、腹部或骨盆内有任何异常，也未确定症状的原因。出院后 2 天，他再次出现晕厥发作、腹痛和血红蛋白水平显著下降。这次，肠系膜动脉 CT 血管造影显示两个肝动脉假性动脉瘤和大量血腹。肝动脉栓塞治疗后，检查显示假性动脉瘤的可能病因是罕见的多发性大动脉炎的首次表现。本例强调了考虑动脉瘤破裂可能性的重要性，特别是在排除了常见的急性腹痛原因后，不要依赖以前的阴性检查来排除病理，因为这样的结果可能是有害的。
