Goverde P, Van Schil P, Delrue F, d'Archambeau O, Vanmaele R, Eyskens E
Department of Surgery, University Hospital of Antwerp, Belgium.
Acta Chir Belg. 1996 Sep-Oct;96(5):233-6.
A 37-year-old man was referred with thoracic pain after a deceleration trauma. He also had a cerebral contusion and a wrist fracture. There were no sings of hypovolemic shock. Computerized tomography (CT) of the chest and transoesophageal echocardiography (TEE) demonstrated a type B aortic dissection originating just distal to the left subclavian artery. There was a patent false lumen without rupture or distal ischaemia. Conservative treatment was given. A paralytic ileus developed and abdominal complaints persisted for several months. Angiography showed normal patency of mesenteric vessels. On follow-up, 3 years after the accident a slight aortic dilation was found on CT thorax without development of a post-dissection aneurysm. Blunt thoracic injury to the aorta usually gives rise to aortic rupture in the region of the isthmus, which can be complete or partial. In the latter case a false aneurysm may develop. An intimal tear after blunt trauma leading to type B aortic dissection rarely occurs. General principles regarding treatment of type B dissection also apply to this particular condition.
一名37岁男性在减速创伤后因胸痛前来就诊。他还伴有脑挫裂伤和腕部骨折。没有低血容量性休克的体征。胸部计算机断层扫描（CT）和经食管超声心动图（TEE）显示为B型主动脉夹层，起源于左锁骨下动脉远端。存在一个通畅的假腔，没有破裂或远端缺血。给予了保守治疗。出现了麻痹性肠梗阻，腹部不适持续了数月。血管造影显示肠系膜血管通畅正常。在事故发生3年后的随访中，胸部CT发现主动脉有轻微扩张，未形成夹层后动脉瘤。钝性胸部主动脉损伤通常会导致主动脉峡部区域破裂，可为完全性或部分性。在后一种情况下，可能会形成假性动脉瘤。钝性创伤后导致B型主动脉夹层的内膜撕裂很少见。B型夹层的一般治疗原则也适用于这种特殊情况。
