Koike Hirofumi, Sueyoshi Eijun, Somagawa Chika, Ideguchi Reiko, Morikawa Minoru, Toya Ryo
Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, Nagasaki, Japan.
Eur Radiol. 2025 May 8. doi: 10.1007/s00330-025-11650-w.
Pulmonary artery adventitial hematoma (PAAH) is a potential complication of aortic dissection (AD) that has been shown to have a deleterious effect on prognosis. However, the specific relationship between PAAH secondary to the rupture of type A AD with early mortality has not been fully characterised. We aimed to evaluate the relationship betweeen PAAH and the short-term prognosis of patients with this condition, and to determine how PAAH impacts the prognosis of patients with type A AD compared with other complications of type A AD.
We retrospectively studied 344 patients with type A AD who were hospitalised at a single institution (164 men and 180 women with a mean [SD] age of 71.0 [12.6] years). These patients were allocated to two groups, comprising those who died within 1 week of the onset of symptoms (early mortality group; n = 33) and those who survived (survival group; n = 311). PAAH was classified according to the CT findings as stage 1 (only in the mediastinum), stage 2 (extending into the lung field ± the interlobular septa), or stage 3 (extending into the alveoli).
The patient cohort was comprised of 90 (26.2%) patients with PAAH of 344 patients with type A AD. 16 (48.5%) of 33 patients had PAAH in the early mortality group, and 74 (23.8%) of 311 patients had PAAH in the survival group. The early mortality group had higher prevalences of PAAH (p = 0.002), stage 3 PAAH (p < 0.001), pericardial haemorrhage (p = 0.001), mediastinal haemorrhage (p < 0.001), haemothorax (p < 0.001), renal ischaemia (p = 0.002), limb ischaemia (p = 0.001) and myocardial ischaemia (p = 0.004) than the survival group. Furthermore, multivariate analysis showed that age (p = 0.002), stage 3 PAAH (p < 0.001), limb ischaemia (p = 0.010), and myocardial ischaemia (p = 0.001) were risk factors for early mortality.
PAAH is not a rare complication of type A AD, and stage 3 PAAH is a risk factor for early mortality.
Question PAAH due to ruptured type A AD can occur and has been reported to correlate with prognosis. Findings PAAH is not a rare complication of Stanford type A AD, and Stage 3 PAAH is a risk factor with the greatest prognostic value on early mortality. Clinical relevance Knowing that PAAH often occurs with type A AD can help us avoid misdiagnosing stage 3 PAAH as pneumonia or pulmonary oedema.
肺动脉外膜血肿（PAAH）是主动脉夹层（AD）的一种潜在并发症，已被证明对预后有有害影响。然而，继发于A型AD破裂的PAAH与早期死亡率之间的具体关系尚未完全明确。我们旨在评估PAAH与该病患者短期预后之间的关系，并确定与A型AD的其他并发症相比，PAAH如何影响A型AD患者的预后。
我们回顾性研究了在单一机构住院的344例A型AD患者（164例男性和180例女性，平均[标准差]年龄为71.0[12.6]岁）。这些患者被分为两组，包括症状发作后1周内死亡的患者（早期死亡组；n = 33）和存活的患者（存活组；n = 311）。根据CT结果，PAAH分为1期（仅在纵隔）、2期（延伸至肺野±小叶间隔）或3期（延伸至肺泡）。
在344例A型AD患者中，有90例（26.2%）患有PAAH。早期死亡组的33例患者中有16例（48.5%）患有PAAH，存活组的311例患者中有74例（23.8%）患有PAAH。早期死亡组的PAAH（p = 0.002）、3期PAAH（p < 0.001）、心包出血（p = 0.001）、纵隔出血（p < 0.001）、血胸（p < 0.001）、肾缺血（p = 0.002）、肢体缺血（p = 0.001）和心肌缺血（p = 0.004）的患病率高于存活组。此外，多变量分析显示年龄（p = 0.002）、3期PAAH（p < 0.001）、肢体缺血（p = 0.010）和心肌缺血（p = 0.001）是早期死亡的危险因素。
PAAH不是A型AD的罕见并发症，3期PAAH是早期死亡的危险因素。
问题 由A型AD破裂引起的PAAH可能发生，并且据报道与预后相关。发现 PAAH不是斯坦福A型AD的罕见并发症，3期PAAH是对早期死亡率具有最大预后价值的危险因素。临床意义 了解PAAH常与A型AD同时发生有助于我们避免将3期PAAH误诊为肺炎或肺水肿。
