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面具背后:一名年轻男性患者瓦尔萨尔瓦窦瘤破裂的误诊——病例报告及文献综述

Hidden behind the mask: misdiagnosis of a ruptured sinus of Valsalva aneurysm in a young male patient-a case report and review of literature.

作者信息

Mi Junqiao, Cao Xiaodan, Zhou Jinfeng

机构信息

Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035, China.

出版信息

J Med Case Rep. 2025 Apr 7;19(1):163. doi: 10.1186/s13256-025-05143-z.

Abstract

BACKGROUND

Sinus of Valsalva aneurysm is a relatively rare disease accompanied by several severe complications. Patients with an unruptured sinus of Valsalva aneurysm are usually asymptomatic or present with symptoms of dyspnea, easy fatigability, palpitations, or chest pain, whereas a ruptured sinus of Valsalva aneurysm may cause severe symptoms including heart failure, myocardial ischemia, or even cardiac arrest. Misdiagnosis is common in clinical practice owing to the rarity of sinus of Valsalva aneurysm and its highly variable, often atypical clinical presentations, which can mimic more common conditions.

CASE PRESENTATION

We present a rare and interesting case of a patient with a ruptured sinus of Valsalva aneurysm, a 33-year-old Chinese man who was misdiagnosed owing to a series of atypical symptoms, including eyelid and facial edema and dyspepsia. Fortunately, the patient was finally diagnosed with ruptured sinus of Valsalva aneurysm, and transthoracic echocardiography showed the noncoronary sinus of Valsalva aneurysm, which ruptured into the right atrium, accompanied by cardiac enlargement and pericardial effusion.

CONCLUSION

This case highlights the importance of obtaining a complete history and a standardized physical examination, and emphasizes the need to consider ruptured sinus of Valsalva aneurysm in young patients presenting with sudden heart failure without a prior cardiac history, and that transthoracic echocardiography is important in providing an accurate and rapid sinus of Valsalva aneurysm diagnosis.

摘要

背景

瓦氏窦瘤是一种相对罕见的疾病,伴有多种严重并发症。未破裂的瓦氏窦瘤患者通常无症状,或表现为呼吸困难、易疲劳、心悸或胸痛等症状,而破裂的瓦氏窦瘤可能导致严重症状,包括心力衰竭、心肌缺血甚至心脏骤停。由于瓦氏窦瘤罕见且临床表现高度多变、常不典型,可模仿更常见的病症,因此临床误诊很常见。

病例报告

我们报告一例罕见且有趣的瓦氏窦瘤破裂患者,一名33岁的中国男性,因一系列非典型症状,包括眼睑和面部水肿及消化不良而被误诊。幸运的是,该患者最终被诊断为瓦氏窦瘤破裂,经胸超声心动图显示非冠状动脉窦的瓦氏窦瘤破裂入右心房,伴有心脏扩大和心包积液。

结论

该病例突出了获取完整病史和进行标准化体格检查的重要性,并强调对于无心脏病史而突发心力衰竭的年轻患者,需要考虑瓦氏窦瘤破裂,且经胸超声心动图对于准确快速诊断瓦氏窦瘤很重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6727/11974064/5ee90ce98b0f/13256_2025_5143_Fig1_HTML.jpg

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