新版主动脉急症的CT诊断课件

急诊室经常遇到的急性主动脉疾病1

急诊室经常遇到的急性主动脉疾病1内容急性主动脉综合征主动脉夹层（AD）—壁内血肿（IMH）—穿透性溃疡（PAU）主动脉瘤

—胸，腹破裂和即将破裂的迹象AcuteAorticSyndrome-AorticDissection(AD)IntramuralHematoma(IMH)PenetratingAtheroscleroticUlcer(PAU)AorticAneurysm–Thoracic,AbdominalRuptureandImpendingRuptureSigns2

内容急性主动脉综合征AcuteAorticSyndrom

AORTICDISSECTION主动脉夹层Mostcommoncauseofacuteaorticsyndrome(70%)Anintimaltearwithseparationoftheaorticmediaintotwolayers急性主动脉综合征最常见的原因（70%）主动脉壁内膜被分离成两层3

AORTICDISSECTION主动脉夹层MostcClassification分类TypeADissectionTypeBDissection4

Classification分类TypeADissecTypeA:>90%diewithin3monthsifnottreated

urgentoperationTypeB:medicationsorinterventionaltreatmentA型：如不紧急手术治疗，三个月内死亡率大于90%；B型：药物或介入治疗60%–70%30%–40%5

TypeA:>90%diewithin3monChestRadiographicFindings

胸片表现normalin10-40%widenedmediastinum61.1%displacementofaorticcalcification14.1%abnormalcardiaccontour25.8%正常10-40%纵隔增宽61.1%主动脉钙化14.1%心脏异常轮廓25.8%6

ChestRadiographicFindings

胸片

RoleofMDCTangiography

动脉CTA作用(1)Sitesofprimaryentryandre-entry;(2)Intimomedialflap,falseandtruelumen;(3)Extentofthedissection(4)Evidenceofrupture;(5)Involvementoftheaorticbranches;(6)Abdominalaorticbranchpatencyandevidenceofend-organmalperfusion;(7)Morphologyanddiameteroftheaortaalongwiththepatency,sizeandtortuosityoftheiliacandfemoralarteries(usefulforendovasculartreatmentplanning)(1)破裂入口和出口;(2)内膜片，真假腔(3)夹层的程度(4)破裂的证据；

(5)主动脉分支受累；(6)腹主动脉分支通畅和终末器官灌注不良的证据；(7)沿着通畅主动脉的形态和直径，髂动脉和股动脉的大小和扭曲（有助于血管内治疗计划）7

RoleofMDCTangiography

动脉CTUnenhancedCT平扫UnenhancedCT:-internaldisplacementofintimalcalcificationsContrast-enhancedCT:

-intimalflapthatseparatesthetruelumenfromthefalselumen

CT平扫—钙化内膜内移增强CT—内膜片分离出真假腔8

UnenhancedCT平扫UnenhancedCTClassification：StanfordtypeA9

Classification：StanfordtypeStanfordtypeB10

StanfordtypeB10FalselumenLargercrosssectionalarea(Pfalse≥Ptrue)Delayedenhancement/thrombosisBeaksign；CobwebsignTruelumen:itscontinuitywithanundissectedportionoftheaortaCobwebsignBeaksign假腔截面积大(假腔≥真腔)延迟强化/血栓形成Beaksign；Cobwebsign真腔:一直延续11

FalselumenCobwebsignBeaksigComplicationsofThoracicAD并发症AcuteaorticregurgitationMajorarchvesselobstruction,coronaryarteryinvolvementAorticrupture–pericardium

tamponade,leftpleuralcavity,mediastinum急性主动脉瓣关闭不全主动脉弓阻塞冠状动脉受累主动脉破裂——心包填塞，左胸腔、纵隔12

ComplicationsofThoracicAD并发ComplicationsofAbdominalAD并发症MainabdominalarterialbranchinvolvementAorticrupture:hemoperitoneum1主腹动脉分支受累——2主动脉破裂腹腔积血13

ComplicationsofAbdominalAD并Malperfusion灌注不良Mortality死亡率:38~50%IncidenceMaincoronaryartery 4.7~7%主冠状动脉Carotid 6.6~28%颈动脉Subclavianartery 5.6~17%锁骨下动脉SMA 2.3~11.9%肠系膜上动脉Renalartery 3.2~12.4%肾动脉Intercostala.forspinalcirculation1.8~6.8%肋间动脉如脊髓循环Iliofemoralartery 13.2~30%髂股动脉14

Malperfusion灌注不良Mortality死亡率:BranchVesselObstruction分支血管阻塞StaticOcclusion:IntimalflapentersthebranchvesseloriginThrombusformationinthefalselumenDynamicOcclusion:IntimalflapcoversthevesseloriginlikeacurtainArteryarisingfromthetruelumeniscompromised静态闭塞：内膜片进入分支血管的起始处，血栓形成——在假腔动态闭塞：内膜片像窗帘覆盖血管起始处，起源真腔的动脉受到损害15

BranchVesselObstruction分支血管阻Dynamicocclusion:动态闭塞-truelumenresemblesaC-shapedenvelopethatispredominantlyconcavetowardthefalselumen-treatedwithafenestrationprocedureTypesofbranch-vesselocclusion

分支血管闭塞的类型16

Dynamicocclusion:动态闭塞TypesofStaticocclusion:静态闭塞-intimalflapintersectsorentersthebranch-vesselorigin-treatedlocallywithanintravascularstentTypesofbranch-vesselocclusion17

Staticocclusion:静态闭塞Typesof陷阱PitfallsofMDCTNonECG-gatedCT:motionartifactpericardialrecessmuralthrombusinafusiformaneurysmPeriaorticfibrosisormediastinal,pulmonary,orretroperitonealtumors…PericardialRecess18

陷阱PitfallsofMDCTNonECG-gateECG-gatedVs.Non-ECG-gated19

ECG-gatedVs.Non-ECG-gatedManagementofacuteaorticdissection20

ManagementofacuteaorticdisHowtowritereportExtentofdissectionLocationofintimaltearIdentificationoftrue/falselumenMalperfusion :sidebranchinvolvementAssociatedfindings21

HowtowritereportExtentofdINTRAMURALHEMATOMA

壁间血肿Spontaneousruptureofthevasavasoruminthe

aorticwallAbloodcollectionwithintheaorticwallwithrestrictedflow/“dissectionwithrestrictedflow”22

INTRAMURALHEMATOMA

壁间血肿SpontaPrecontrastCT,narrowwindow“Hyperattenuatingcrescent”onprecontrastCTNocontrastenhancement,smoothmargin30%rateofprogressiontoovertaorticdissectionAcuteIntramuralHematoma急性壁间血肿

23

PrecontrastCT,narrowwindowASubacute

IntramuralHematoma

亚急性壁间血肿SubacuteandchronicIMH(1weekaftertheonsetofsymptoms)Decreasedattenuation(identicaltothatinintraluminalblood)24

SubacuteIntramuralHematoma

亚DifferentiationofacuteIMHfrommuralthrombusorthrombosedfalselumenseeninADMuralthrombus:

moreirregularlumen,non-displacedintimalcalcification,morecommoninabdominalaorta,associatedwithaneurysm附壁血栓：更不规则腔，非移位性内膜钙化，更常见于腹主动脉，合并动脉瘤IMHADw/thrombosedfalselumenMuralthrombus25

DifferentiationofacuteIMHfADfalselumenthrombosis:multilayeredpatternofincreasingattenuationintimalflap(whenyouscrollupanddown..)RadioGraphics2009;29:791–804AD26

ADfalselumenthrombosis:RadNaturalhistoryofIMH10%16-47%20-45%27

NaturalhistoryofIMH10%16-47Canresolve：followed2months.28

Canresolve：followed2months.(a)UnenhancedaxialCTimage

obtainedatpresentationdepictsatype

Baorticintramuralhematoma(arrow).(b)Contrastenhanced

axialCTimageobtained1

monthlatershowsanenhancingulcerlike

projection(arrow),afindingsuggestive

ofanewintimaltear.(c)Contrastenhanced

axialCTimageobtained2

monthslatershowsovertdissection(arrow).Canprogresstodissectionwithulcerlikeprojectionanddissection…29

(a)UnenhancedaxialCTimageCanprogresstofusiformaneurysm…可进展为梭形动脉瘤(a,b)UnenhancedaxialCTimagesobtainedatpresentationdepictatypeBhematoma.(c)Contrast-enhancedaxialCTimageobtained2yearslatershowsafusiformaneurysm

atthesiteoftheinitialaorticintramuralhematoma.30

Can(a,b)UnenhancedaxialCT

F/70acutechestandupperbackpain2008-02-18CTAngiography31

F/70acutechestanduppObservation

acutechestpain2008-04-26CTAngiography32

Observationacutechestpain20DifferentialDiagnosis鉴别诊断PericaridalrecessAortitis:diffuse,circumferentialinvolvementRetroperitonealfibrosisorperiaorticlymphomaThickenedaorticwallenhancesMorecommonlyinvolveabdominalaortaCircumferentialRetroperitonealfibrosisPericardial

Recesspericaridal隐窝主动脉炎：弥漫，环周受累腹膜后纤维化或腹主动脉旁淋巴主动脉壁增厚更常见的涉及腹主动脉环33

DifferentialDiagnosis鉴别诊断Peri

F/23palpitation,HA2010-07-07CTAngiography40HU75HUTakayasu’sarteritis34

F/23palpitation,HA2010TypeBIMHPrimarilyconservativeSurgeryorstent-graftifrecurring,refractorychestpain,evidenceofincreasingextentanddiameterTypeAIMHEmergencyoperationifthereiscardiactamponade,impendingrupture,orruptureConservativetreatment35

TypeBIMH35HowtowritereportExtentofIMH:typeAorBPresence/absenceofPAUorintimaltearIfpresent,locationofPAUorintimaltearSignsofrupture/progression36

HowtowritereportExtentofIPENETRATINGAORTICULCER

穿透性溃疡Ulcerationofatheroscleroticplaque-Disruptionoftheaorticmedia-Medialhematomaformation,localized-Potentialforrupture-FalseaneurysmformationMid-thoracicordistaldescendingaortaDefinition:ulcerationofanaorticatheroscleroticplaquepenetratingthroughtheinternalelasticlaminaintothemedia。主动脉粥样斑块溃疡穿透内弹性膜进入管腔37

PENETRATINGAORTICULCER

穿透性Plaqueulceration斑块溃疡Adventitialpseudoaneurysm血管外膜假性动脉瘤Transmuralrupture透壁破裂Intimalplaqueulceration内膜斑块溃疡Medialhematoma内侧血肿PenetratingAtheroscleroticUlcer穿透性溃疡38

PlaqueAdventitialTransmuralNaturalhistoryofPAUInitialdiameter≥20mmordepth≥10mm39

NaturalhistoryofPAUInitialCTFindingsFocalcontrast-material-filledpouchcommunicatingwiththeaorticlumenbutextendingoutwardbeyonditsexpectedaorticwallboundaries40

CTFindingsFocalcontrast-mate

M/88acuteLt.chestpain,underlyingAGC2005-05-06ChestCT41

M/88acuteLt.chestpain

42/51

DDxofAorticUlcerationAtheromatousUlcerNoextensionbeyondexpectedmarginofaorticwallNohematomaPAUAcute,lifethreateningSometimeswithIMH,hematomaorsofttissueinfiltrationIrregularmarginIMHConcentricallylocatedcollectionofbloodwithinmediasmoothlyADIntimalflapextendsacrossaortaLengthmoreextensive43

DDxofAorticUlcerationAthero44

44AorticAneurysmThoracicaorticaneurysmPermanentabnormaldilationoftheaorta1.5morethannormaldiameter>5cmindiameterNormalvalue:AscTA<4cm/DescTA<3cmAbdominalaorticaneurysm>3cmindiameter45

AorticAneurysm45

46/65AorticAneurysmCausesAtherosclerosisMarfan’sAortitisTakayasu’sBehcet’sGiantcellMycoticSyphyliticTraumaticTruevs.pseudoFusiformvs.Saccular

47/51AbdominalAorticAneurysmOpindicationDiameterover5.5cmRapidsizeincrease7mm/6month10mm/1yearAnnualriskofrupture<4cm 0%4-5cm 5%5-6cm 5-10%6-7cm 10-20%7-8cm 20-40%>8cm 40-60%

48/51ImpendingRupturePainGrowing:1cm/6moPerianeurysmal

hemorrhageHyperdensecresentIMHorintrathrombichemorrhageDensityheterogeneityofintramuralthrombiEccentriclumenwiththinwallFocaldiscontinuityofcal.RimRecentlyabruptbreak

FindingsofImpendingRuptureIncreasedaneurysmsize

：diameter>7cm+acutesymptoms（TAA>6cm,AAA>7.2cm）Thrombusandcalcifications

:thrombustolumenratiodecreasesasaneurysmincrease；thickcircumferentialthrombusisprotectiveagainstruptureHyperattenuatingcrescentsign:acuteorimpendingrupture(refertoPRECONTRASTCT!)Drapedaortasign:containedrupture49

FindingsofImpendingRuptureIFindingsofAneurysmRupture

动脉瘤破裂表现TAA:Hemopericardium,Hemomediastinum,Hemothorax(Lt)—心包、纵膈、胸腔积血Aortobronchial,AortoesophagealfistulaAAA:Retroperitonealhematoma(Periaorticbloodextendingintotheperirenal,pararenalspaceorpsoasmuscles)AortoentericfistulaExtravasation:immediateordelayedfindingsFocaldiscontinuityincircumferentialcalcificationsunstableorrupturedaneurysm50

FindingsofAneurysmRupture

动

51/51ImpendingRupture先兆破裂M/70

Aneurysmruptureina65-year-oldman.NonenhancedCTscanshowsarupturedatheroscleroticaneurysmofthedescendingthoracicaorta.Notethehigh-attenuationfluidintheleftpleuralspace,a

findingthatrepresentsacutehemothorax.52

Aneurysmruptureina65-year-Aortobronchialfistula主动脉支气管瘘Aortoesophagealfistula食管主动脉瘘53

AortobronchialfistulaAortoeso2011-11-07outsideCT

M/73Hemoptysis54

2011-11-07outsideCTM/755

5556

56Aortoentericfistula57

Aortoentericfistula5758

58

59/51InfrarenalAAA

Hyperdensecrescentrimvs.AcuteIMH

高密度新月形边缘与急性IMHHistologically,hyperdensecrescentrimseenatCTinlargeabdominalaorticaneurysmiscausedbyfreshbloodthatfirstinsinuatesitselfintothemuralthrombusandlaterpenetratesintotheaorticwallIMHiscausedbyhemorrhagewithintheaorticwallAAAismorecommonlyassociatedwithachronicIMHthanwithanacuteorsubacuteoneHyperattenuatingcrescentinassociationwithfusiformaneurysmisdiscordantwithsubacuteoracuteIMH60

Hyperdensecrescentrimvs.Ac61

6162

62Impendingrupture；IncreasedsizeofinfrarenalAAA

6.5cm-->7.1cm.

M/68abdominalpain2008-11-27CTAngiographyImpendingrupture.ContainedrupturecasesIncreasedsizeofinfrarenalAAA

6.5cm-->7.1cm.63

Impendingrupture；IncreasedsiHowtowritereportExtentofaneurysmSerialchangeofaneurysm

sizeProximalnecklength(fromleftrenalartery:AAA)FeatureofimpendingruptureAssociatedfindings64

HowtowritereportExtentofaInfected(Mycotic)Aneurysm

感染（真菌）动脉瘤mostoftenpseudoaneurysm,pronetorupture(53-75%)endocarditisrelatedsepticemia/directpropagationfromadjacentvertebralOM,renalorpsoasmuscleabscess..Findingssaccularshape,lobularcontours,eccentricthrombusperiaorticinflammation,abscess,andmassperiaorticgasandadjacentvertebralbodyabnormalitiesduetothespreadofinfectionfastexpansionovertime65

Infected(Mycotic)Aneurysm

感染66

6639067380F/73Forfeverfocusw/u2010-01-28AbdomenCT67

39067380F/73ForfeverfocuSUV3.82010-03-11CTAngiography68

SUV3.82010-03-11CTAngiograp42231815M/71chestpain2011-09-12outsideChestCT69

42231815M/71chestpain2011HU202011-10-13CTAngiography70

HU202011-10-13CTAngiography

TraumaticAorticInjury(TAI)

外伤性主动脉损伤SeveredecelerationHighspeedmotorvehicleaccidentFallfromagreatheightImmediatedeathin80-90%Untreated:1%perhourfor48h71

TwoTheoryShearbtwfixedarch/mobiledescendingaortaOsseouspinchbtwspine/anteriorbonycomplexRadioGraphics1997;2772

TraumaticAorticInjury73

74

TraumaticAorticInjury(TAI)

外伤性主动脉损伤MostcommonsitesAorticisthmus(90%)Ascendingaorta(5-10%)Descendingaortaneardiaphragmaticiatus(1-3%)75

PDAremnant76

Directsign直接征象PseudoaneurysmAbnormalaorticcontourAbruptchangeinaorticcaliberKinkingofaorta(pseudocoarctation)SegmentalocclusionofaortaIntimalflapExtravasationofcontrastagentisrare假性动脉瘤主动脉轮廓异常主动脉管径突变主动脉迂曲（假性狭窄）主动脉段闭塞内膜瓣造影剂外渗是罕见的77

RadioGraphics1997;2778

F/71Motorvehicleaccident(1MA)79

F/71792006-03-28chestCT80

2006-03-28chestCT80Oneweeklater2006-04-05CTangiographythoracicaorta81

Oneweeklater2006-04-05CTan2006-04-06CTangiography3DVR,curvedMPR82

2006-04-06CTangiography3DV

RadioGraphics2008;155583

Indirectsign-Lessspecific

间接征象-缺乏特异性MediastinalorretrocruralhematomaNotspecificCanbefrommediastinalvenousbleedingObscurefatplanesurroundingaortaorarchvessels

suspiciousforoccultacuteTAIfurtheraortography84

M/40Hoarseness(1MA)85

M/408586

86

87/51TraumaticAorticInjury

88/51

ReferencesAnesthesiaandPerioperativeCareforAorticSurgery,K.Subramaniametal.(eds.),2011theJournalofThoracicandCardiovascularSurgery,2010,140,S92-97RadioGraphics2010;30:445–460 RadioGraphics2009;29:537–552RadioGraphics2007;27:497–507RadioGraphics2010;30:851–867RadioGraphics2009;29:791–804AsianCardiovascThoracAnn2010;18:456-463Heart2001;85:365–368

89

ReferencesAnesthesiaandPerio结束语当你尽了自己的最大努力时，失败也是伟大的，所以不要放弃，坚持就是正确的。WhenYouDoYourBest,FailureIsGreat,SoDon'TGiveUp,StickToTheEnd结束语谢谢大家荣幸这一路，与你同行It'SAnHonorToWalkWithYouAllTheWay演讲人：XXXXXX时间：XX年XX月XX日

谢谢大家演讲人：XXXXXX急诊室经常遇到的急性主动脉疾病92

急诊室经常遇到的急性主动脉疾病1内容急性主动脉综合征主动脉夹层（AD）—壁内血肿（IMH）—穿透性溃疡（PAU）主动脉瘤

—胸，腹破裂和即将破裂的迹象AcuteAorticSyndrome-AorticDissection(AD)IntramuralHematoma(IMH)PenetratingAtheroscleroticUlcer(PAU)AorticAneurysm–Thoracic,AbdominalRuptureandImpendingRuptureSigns93

内容急性主动脉综合征AcuteAorticSyndrom

AORTICDISSECTION主动脉夹层Mostcommoncauseofacuteaorticsyndrome(70%)Anintimaltearwithseparationoftheaorticmediaintotwolayers急性主动脉综合征最常见的原因（70%）主动脉壁内膜被分离成两层94

AORTICDISSECTION主动脉夹层MostcClassification分类TypeADissectionTypeBDissection95

Classification分类TypeADissecTypeA:>90%diewithin3monthsifnottreated

urgentoperationTypeB:medicationsorinterventionaltreatmentA型：如不紧急手术治疗，三个月内死亡率大于90%；B型：药物或介入治疗60%–70%30%–40%96

TypeA:>90%diewithin3monChestRadiographicFindings

胸片表现normalin10-40%widenedmediastinum61.1%displacementofaorticcalcification14.1%abnormalcardiaccontour25.8%正常10-40%纵隔增宽61.1%主动脉钙化14.1%心脏异常轮廓25.8%97

ChestRadiographicFindings

胸片

RoleofMDCTangiography

动脉CTA作用(1)Sitesofprimaryentryandre-entry;(2)Intimomedialflap,falseandtruelumen;(3)Extentofthedissection(4)Evidenceofrupture;(5)Involvementoftheaorticbranches;(6)Abdominalaorticbranchpatencyandevidenceofend-organmalperfusion;(7)Morphologyanddiameteroftheaortaalongwiththepatency,sizeandtortuosityoftheiliacandfemoralarteries(usefulforendovasculartreatmentplanning)(1)破裂入口和出口;(2)内膜片，真假腔(3)夹层的程度(4)破裂的证据；

(5)主动脉分支受累；(6)腹主动脉分支通畅和终末器官灌注不良的证据；(7)沿着通畅主动脉的形态和直径，髂动脉和股动脉的大小和扭曲（有助于血管内治疗计划）98

RoleofMDCTangiography

动脉CTUnenhancedCT平扫UnenhancedCT:-internaldisplacementofintimalcalcificationsContrast-enhancedCT:

-intimalflapthatseparatesthetruelumenfromthefalselumen

CT平扫—钙化内膜内移增强CT—内膜片分离出真假腔99

UnenhancedCT平扫UnenhancedCTClassification：StanfordtypeA100

Classification：StanfordtypeStanfordtypeB101

StanfordtypeB10FalselumenLargercrosssectionalarea(Pfalse≥Ptrue)Delayedenhancement/thrombosisBeaksign；CobwebsignTruelumen:itscontinuitywithanundissectedportionoftheaortaCobwebsignBeaksign假腔截面积大(假腔≥真腔)延迟强化/血栓形成Beaksign；Cobwebsign真腔:一直延续102

FalselumenCobwebsignBeaksigComplicationsofThoracicAD并发症AcuteaorticregurgitationMajorarchvesselobstruction,coronaryarteryinvolvementAorticrupture–pericardium

tamponade,leftpleuralcavity,mediastinum急性主动脉瓣关闭不全主动脉弓阻塞冠状动脉受累主动脉破裂——心包填塞，左胸腔、纵隔103

ComplicationsofThoracicAD并发ComplicationsofAbdominalAD并发症MainabdominalarterialbranchinvolvementAorticrupture:hemoperitoneum1主腹动脉分支受累——2主动脉破裂腹腔积血104

ComplicationsofAbdominalAD并Malperfusion灌注不良Mortality死亡率:38~50%IncidenceMaincoronaryartery 4.7~7%主冠状动脉Carotid 6.6~28%颈动脉Subclavianartery 5.6~17%锁骨下动脉SMA 2.3~11.9%肠系膜上动脉Renalartery 3.2~12.4%肾动脉Intercostala.forspinalcirculation1.8~6.8%肋间动脉如脊髓循环Iliofemoralartery 13.2~30%髂股动脉105

Malperfusion灌注不良Mortality死亡率:BranchVesselObstruction分支血管阻塞StaticOcclusion:IntimalflapentersthebranchvesseloriginThrombusformationinthefalselumenDynamicOcclusion:IntimalflapcoversthevesseloriginlikeacurtainArteryarisingfromthetruelumeniscompromised静态闭塞：内膜片进入分支血管的起始处，血栓形成——在假腔动态闭塞：内膜片像窗帘覆盖血管起始处，起源真腔的动脉受到损害106

BranchVesselObstruction分支血管阻Dynamicocclusion:动态闭塞-truelumenresemblesaC-shapedenvelopethatispredominantlyconcavetowardthefalselumen-treatedwithafenestrationprocedureTypesofbranch-vesselocclusion

分支血管闭塞的类型107

Dynamicocclusion:动态闭塞TypesofStaticocclusion:静态闭塞-intimalflapintersectsorentersthebranch-vesselorigin-treatedlocallywithanintravascularstentTypesofbranch-vesselocclusion108

Staticocclusion:静态闭塞Typesof陷阱PitfallsofMDCTNonECG-gatedCT:motionartifactpericardialrecessmuralthrombusinafusiformaneurysmPeriaorticfibrosisormediastinal,pulmonary,orretroperitonealtumors…PericardialRecess109

陷阱PitfallsofMDCTNonECG-gateECG-gatedVs.Non-ECG-gated110

ECG-gatedVs.Non-ECG-gatedManagementofacuteaorticdissection111

ManagementofacuteaorticdisHowtowritereportExtentofdissectionLocationofintimaltearIdentificationoftrue/falselumenMalperfusion :sidebranchinvolvementAssociatedfindings112

HowtowritereportExtentofdINTRAMURALHEMATOMA

壁间血肿Spontaneousruptureofthevasavasoruminthe

aorticwallAbloodcollectionwithintheaorticwallwithrestrictedflow/“dissectionwithrestrictedflow”113

INTRAMURALHEMATOMA

壁间血肿SpontaPrecontrastCT,narrowwindow“Hyperattenuatingcrescent”onprecontrastCTNocontrastenhancement,smoothmargin30%rateofprogressiontoovertaorticdissectionAcuteIntramuralHematoma急性壁间血肿

114

PrecontrastCT,narrowwindowASubacute

IntramuralHematoma

亚急性壁间血肿SubacuteandchronicIMH(1weekaftertheonsetofsymptoms)Decreasedattenuation(identicaltothatinintraluminalblood)115

SubacuteIntramuralHematoma

亚DifferentiationofacuteIMHfrommuralthrombusorthrombosedfalselumenseeninADMuralthrombus:

moreirregularlumen,non-displacedintimalcalcification,morecommoninabdominalaorta,associatedwithaneurysm附壁血栓：更不规则腔，非移位性内膜钙化，更常见于腹主动脉，合并动脉瘤IMHADw/thrombosedfalselumenMuralthrombus116

DifferentiationofacuteIMHfADfalselumenthrombosis:multilayeredpatternofincreasingattenuationintimalflap(whenyouscrollupanddown..)RadioGraphics2009;29:791–804AD117

ADfalselumenthrombosis:RadNaturalhistoryofIMH10%16-47%20-45%118

NaturalhistoryofIMH10%16-47Canresolve：followed2months.119

Canresolve：followed2months.(a)UnenhancedaxialCTimage

obtainedatpresentationdepictsatype

Baorticintramuralhematoma(arrow).(b)Contrastenhanced

axialCTimageobtained1

monthlatershowsanenhancingulcerlike

projection(arrow),afindingsuggestive

ofanewintimaltear.(c)Contrastenhanced

axialCTimageobtained2

monthslatershowsovertdissection(arrow).Canprogresstodissectionwithulcerlikeprojectionanddissection…120

(a)UnenhancedaxialCTimageCanprogresstofusiformaneurysm…可进展为梭形动脉瘤(a,b)UnenhancedaxialCTimagesobtaine