作为急性冠状动脉综合征伪装的大动脉根解剖:血管内超声波的关键作用
Bing Ji1, Yan Lai1, Xue-Bo Liu1
1Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
概括
诊断急性大动脉解剖 (AAD) 很困难,特别是当它模仿急性心肌梗塞 (AMI) 时. 血管内超声波 (IVUS) 对于在异型症状患者中识别ADD至关重要,突出其诊断价值.
科学领域:
- 心脏病学 心脏病学
- 血管外科 血管外科
- 诊断成像 诊断成像 诊断成像
背景情况:
- 急性大动脉解剖 (AAD) 诊断具有挑战性,特别是当症状与急性心肌梗塞 (AMI) 重叠时.
- 患者可能会出现非典型的症状,使初始诊断途径复杂化.
- 心血管疾病的危险因素在患有AAD的患者中很常见.
研究的目的:
- 报告一个被误诊为急性冠状动脉综合征 (ACS) 的AAD病例.
- 要突出血管内超声波 (IVUS) 在诊断AAD时的实用性,当其他方法没有确定性时.
- 强调在患有胸痛和心脏生物标志物升高的患者中考虑AAD的重要性.
主要方法:
- 一个81岁的男性患有心血管疾病风险因素的病例报告.
- 基于症状和心脏生物标志物升高的ACS初步诊断.
- 冠状动脉扫描显示没有阻塞性冠状动脉疾病.
- 血管内超声波 (IVUS) 检查左侧主要骨,发现了暗示主动脉解剖的特征.
- 大动脉计算机断层扫描血管造影 (CTA) 证实了AAD的诊断.
主要成果:
- 患者最初出现的症状和生物标志物与ACS一致.
- 冠状动脉扫描对阻塞性冠状动脉疾病是负面的.
- IVUS揭示了左侧主要骨的低声空间,可疑的剖析.
- CTA证实了涉及大动脉的剖析.
- D-二聚合物水平处于正常范围内,这对于AAD是不典型的.
结论:
- 在诊断AAD时,IVUS可以是一个有价值的工具,特别是在非典型的表现或其他成像是模两可的情况下.
- 在患有暗示ACS的症状的患者中,对AAD的高度怀疑指数至关重要.
- 及时,准确地诊断AAD至关重要,以防止不适当的治疗和指导管理.
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