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一个急性大动脉解剖的病例,由肠道透复杂化
Jing Huang1, Siya Khanna2, Max Macbarb3
1Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA.
Cureus
|September 18, 2024
概括
急性大动脉解剖 (AAD) 呈现出非典型的,具有挑战性的诊断. 这一案例凸显了在患有认知变化和腹部疼痛的患者中高度怀疑的关键需求,即使没有经典的胸痛症状.
科学领域:
- 心脏病学 心脏病学
- 血管外科 血管外科
- 紧急医疗 紧急医疗
背景情况:
- 急性大动脉解剖 (AAD) 是一种具有高死亡率的危急医疗紧急情况.
- 早期诊断和干预对于患者的结果至关重要.
- 典型的表现包括急性胸痛,但非典型的症状可以模糊诊断.
研究的目的:
- 为了呈现一个有异常初始症状的AAD病例.
- 为了强调改变精神状态的患者的诊断挑战.
- 突出了对ADD高度临床怀疑的重要性.
主要方法:
- 一个57岁的男性出现认知失调和腹部疼痛的病例报告.
- 最初的治疗包括实验室检查,胸部放射和CT扫描.
- 计算机断层扫描血管造影 (CTA) 用于调查怀疑的肠道缺血症.
主要成果:
- 患者出现了认知失调,腹痛,恶心,吐,腹,白血球升高,高血糖,急性损伤和乳酸升高.
- 最初的成像对急性发现是负面的;尿液毒理学对可卡因呈阳性.
- CTA揭示了腹部大动脉剖析与外部压缩,后来被确定为A型AAD与广泛的肠道缺血.
结论:
- AAD可以呈现非特异性症状,如认知失调和腹部疼痛.
- 在这种情况下,增加乳酸盐和可卡因的使用应该引起对大动脉病理的怀疑.
- 保持对AAD的高怀疑指数至关重要,特别是在具有异常表现的高风险患者中.
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