Izutani H, Suzuki K, Kuki S, Matsumura R, Okuda A
Department of Cardiovascular Surgery, Osaka Rosai Hospital, Sakai, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Oct;41(10):2136-40.
A 73-year-old patient with acute aortic dissection in delayed shock state following sudden onset of chest-back pain and left sided hemothorax was successfully operated. Contrast enhanced CT demonstrated a crescent-shaped low density area in the descending aorta. Aortography showed ulcer-like projection (ULP) with minor leakage into left thorax, however, a flow in false lumen was not visualized. These findings suggested that the false lumen of type III aortic dissection was thrombosed in its early phase. The aneurysm was transected on left heart bypass through left thoracotomy. The entry of false lumen was found in proximal portion of descending aorta, in which fresh thrombus was filled. A graft was anastomosed and reinforced with felt strips in end-to-end. The postoperative course was uneventful. The ULP by aortography provides a possible sign of rupture in clinical course of aortic dissection.
一名73岁患者，突发胸背部疼痛和左侧血胸后处于延迟休克状态，患有急性主动脉夹层，手术成功。增强CT显示降主动脉有新月形低密度区。主动脉造影显示溃疡样突出（ULP），有少量造影剂漏入左胸腔，但未显示假腔内有血流。这些发现提示III型主动脉夹层的假腔在早期已血栓形成。通过左胸切口在左心转流下横断动脉瘤。在降主动脉近端发现假腔入口，其中充满新鲜血栓。端端吻合人工血管并用毡条加固。术后过程顺利。主动脉造影显示的ULP可能是主动脉夹层临床过程中破裂的一个征象。
