Matsuoka Y, Sakamoto I, Ogawa Y, Sueyoshi E, Hayashi K, Narimatsu M, Takagi M
Department of Radiology, Nagasaki University School of Medicine.
Nihon Igaku Hoshasen Gakkai Zasshi. 1997 Aug;57(9):572-80.
Nineteen patients with Stanford type A acute aortic dissection with closed false lumen were reviewed. In the follow-up examinations, ulcerlike projection (ULP) in the ascending aorta (AA) or aortic arch (AR) was identified in 8 of 19 patients. In 5 of these 8 patients, acute cardiac tamponade occurred and 3 of them died. In the other 11 patients, there was no mortality, and only one patient underwent elective surgery. The appearance of ULP in the AA/AR is considered an indication for urgent surgery because it is regarded as a precursor of lethal complications such as cardiac tamponade. The purpose of this study was to investigate predictors of the appearance of ULP in the AA/AR with early imagings (CT or MRI) before the appearance of ULP. The patients were divided into two groups: patients with ULP in the AA/AR (8 patients) and others (11 patients). Initial CT or MRI findings of the thoracic aorta were retrospectively statistically analyzed in each group. Three predictive factors were statistically significant for the appearance of ULP in the AA/AR (diameter of the AA > or = 5 cm, thickness of the false lumen of the AA > or = 1 cm, thickness of the false lumen of the AA > or = that of the descending aorta). Close attention should be paid, if any of these 3 factors is observed at initial CT or MRI.
回顾了19例Stanford A型急性主动脉夹层且假腔闭合的患者。在随访检查中，19例患者中有8例在升主动脉（AA）或主动脉弓（AR）发现了溃疡样突起（ULP）。在这8例患者中，有5例发生急性心脏压塞，其中3例死亡。在其他11例患者中，无死亡病例，仅1例接受了择期手术。AA/AR中出现ULP被认为是紧急手术的指征，因为它被视为心脏压塞等致命并发症的先兆。本研究的目的是在ULP出现之前，利用早期影像学检查（CT或MRI）研究AA/AR中ULP出现的预测因素。患者分为两组：AA/AR中有ULP的患者（8例）和其他患者（11例）。对每组患者胸主动脉的初始CT或MRI表现进行回顾性统计分析。有三个预测因素对AA/AR中ULP的出现具有统计学意义（AA直径≥5 cm、AA假腔厚度≥1 cm、AA假腔厚度≥降主动脉假腔厚度）。如果在初始CT或MRI检查中观察到这三个因素中的任何一个，都应予以密切关注。
