Le Moigne A, Boudou A, Lelguen J C
J Radiol. 1984 May;65(5):397-400.
A localised rupture of the aorta, notably less frequent than a true dissection, is often difficult to diagnose and should be attentively sought for whenever faced with acute chest pains resulting from a suspected aortic lesion. The authors' observation show, on aortography, a small ulcer-like projection on the internal wall of the dilated ascending aorta, only visible on an antero-posterior view. The true scientific value of this image is arguable and we are reminded of the rigorous routine needed in any angiographical examination. The particular case in question involves a subadventitial ulcer which could be the initial stage of a true dissection. The echography demonstrated the presence of a pericardial effusion (whose dreaded prognostic value is well known), but no aortic lesion. The authors feel that the diagnostic reliability of echography, computed tomography and digital subtraction angiography warrants further systematic study. It would appear that direct aortography until otherwise proved, remains the only real method capable of detecting these localised ruptures at an early stage, before their spontaneous and dramatic evolution into perforation or a true dissection; and so benefiting the patient from surgical repair work only without prosthesis insertion.
主动脉局限性破裂，明显比真正的夹层少见，常常难以诊断，每当面对由可疑主动脉病变引起的急性胸痛时，都应仔细寻找。作者的观察显示，在主动脉造影上，扩张的升主动脉内壁有一个小的溃疡样凸起，仅在前后位视图上可见。该影像的真正科学价值存在争议，这使我们想起任何血管造影检查都需要严格的常规操作。所讨论的特殊病例涉及一个外膜下溃疡，它可能是真正夹层的初始阶段。超声心动图显示有心包积液（其可怕的预后价值众所周知），但未发现主动脉病变。作者认为，超声心动图、计算机断层扫描和数字减影血管造影的诊断可靠性值得进一步系统研究。在另有证据之前，直接主动脉造影似乎仍然是唯一能够在这些局限性破裂自发急剧演变为穿孔或真正夹层之前早期检测到它们的真正方法；从而使患者仅受益于无需植入假体的手术修复。
