主动脉病变CT诊断详解.ppt

(A) Axial CT image in a patient with a Type A IMH involving the ascending and descending thoracic aorta. Curvilinear hypodensities correspond to the intramural hematoma (arrows). (B). Axial CT image in a patient with a Type B IMH (arrow) with calcified aortic adventitia (arrowhead). (C) Axial CT image in a patient with a Type B IMH with extensive hematoma (arrow) circumferentially within the wall of aorta. 老年代谢性疾病，女性绝经后进展迅速 主动脉穿透性溃疡（penetrating aortic ulcer，PAU） 粥样斑块侵蚀主动脉壁内层和弹性膜，中膜内血肿形成 可致主动脉瘤形成或主动脉破裂 囊状动脉瘤多PAU引起 多发生在老龄患者，动脉粥样硬化较重 主动脉弓和降主动脉多见，升主动脉少见 Diagrams illustrate the four stages in the formation of a penetrating atherosclerotic ulcer: (A) aortic atheroma, (B) benign intimal plaque ulceration contained in the intima, (C) medial hematoma with potential adventitial false aneurysm, and (D) transmural rupture. PAU治疗 随访 手术： 适应症：血流动力学不稳定，持续疼痛，主动脉破裂，远端栓塞，主动脉直径快速增大 难度大，并发症多 PAU CT表现 粥样斑块局部溃疡形成，主动脉管腔局部尖角样突起 可单发或多发 Aortic changes due to atherosclerosis in different stages. (A) Aortic atheroma, (B) benign intimal plaque ulceration (white arrow) contained in the intima and (C) medial hematoma (white arrow) with potential adventitial false aneurysm. 主动脉不完全破裂 主动脉完全破裂 外伤性主动脉夹层动脉瘤 外伤性主动脉膜内血肿 CT表现 纵隔内积血 主动脉变形 内移的内膜片 主动脉内血栓 假性动脉瘤 降主动脉逐渐变细 (a) CT scan shows a crescent of periaortic blood surrounding the descending aorta(arrow). (b) CT scan shows a contour deformity, compatible with a pseudoaneurysm, near the ligamentum arteriosus (arrow). Aortic transection in a 39-year-old woman following blunt trauma to the chest. (a) CT scan demonstrates blood in the mediastinum and around the aorta. An intimal flap is present in the descending aorta (arrow). (b) On another scan obtained at a lower level, luminal debris and aortic contour irregularity are noted. Acute blunt chest trauma. Axial CT scans (a, b) show a small amount of blood in the anterior mediastinum but a normal aortic contour. The sternal fracture (arrowhead in b) is the source of blood. (A) Axial CT image demonstrat