主动脉急症的CT诊断.pptVIP

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

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

Classification分类TypeADissectionTypeBDissection4

TypeA:90%diewithin3monthsifnottreatedurgentoperationTypeB: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

ChestRadiographicFindings

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

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

UnenhancedCT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

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Classification：StanfordtypeA10

StanfordtypeB11

FalselumenLargercrosssectionalarea(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12

ComplicationsofThoraci