颈部的假性动脉瘤很少,而由颈部感染尤其是咽旁脓肿引起的则更为罕见。然而,危及生命,可能因气道阻塞和假性动脉瘤破裂而导致猝死。我们分析了临床特征,通过病例总结和文献复习,以指导临床诊断和治疗假性动脉瘤。病人,我们就诊的是一名87岁男性,主诉颈部肿胀7天,呼吸急促2天,急诊入院.颈部超声检查显示,左侧颈总动脉旁有一个约8.0cm×5.0cm的液体暗区,考虑到左颈动脉假性动脉瘤的形成,和右侧可见的液体暗区,被认为是假性动脉瘤或感染。颈部血管造影显示左颈动脉分叉周围有一个聚集的高密度阴影,总体范围约为65mm×52mm×72mm,当然是假性动脉瘤,而在病变的右侧,可以看到与空气混合的低密度阴影,咽旁脓肿是肯定的.随后他被诊断为由咽旁脓肿引起的左颈内动脉假性动脉瘤。气管插管和抗感染治疗后,患者死于假性动脉瘤破裂的失血性休克。此外,我们在PubMed上进行了文献检索,万方数据库和CNKI,关键词为“颈部假性动脉瘤,颈部感染,咽旁脓肿”并纳入10例。然后总结了临床特点和治疗方法。我们分析并总结了10例病例报告,其中男性人数为7。其中,有四个儿科,共纳入6名成年人。大多数症状是颈部肿胀,病变血管主要为右颈内动脉,占整体的一半。所有患者都接受了手术干预,并且恢复得很好。因此我们得出结论,颈部假性动脉瘤的临床发病率较低,可由多种因素引起,尤其是由感染因素引起的。当病人颈部有进行性搏动肿块时,应尽快通过超声进行初步诊断,应使用主动脉增强CT进一步证实。对于由咽旁感染引起的颈部假性动脉瘤的患者,应及时手术配合抗生素治疗。
Pseudoaneurysms of the neck are seldom, and those caused by neck infections especially parapharyngeal abscess are even rarer. However, it is life-threatening and may bring sudden death due to the obstruction of airway and the pseudoaneurysms rupture. We analyzed the clinical features, diagnosis and treatment of the disease through a
case summary and literature review in order to guide clinical diagnosis and treatment of pseudoaneurysms. The patient, whom we presented was an 87-year-old male and admitted in emergency of our hospital with the chief complaint of neck swelling for 7 days and shortness of breath for 2 days. Cervical ultrasound examination showed that there was an liquid dark area next to the left common carotid artery which was approximately 8.0 cm × 5.0 cm, consideration of formation of left carotid artery pseudoaneurysm, and the liquid dark area which was visible on the right considered of pseudoaneurysm or infection. Angiography of neck showed a clustered high-density shadow around the bifurcation of the left carotid artery, with an overall range of approximately 65 mm × 52 mm × 72 mm, the pseudoaneurysms for sure, while on the right side of the lesion, mixed low density shadows with air could be seen, the parapharyngeal abscess for sure.Then he was diagnosed as the pseudoaneurysm of left internal carotid artery which was caused by parapharyngeal abscess. After tracheal intubation and anti-infection treatment, the patient died due to hemorrhagic shock of the ruptured of the pseudoaneurysm. Morever we performed literature search on PubMed, Wanfang database and CNKI with keywords of \"neck pseudoaneurysm, neck infection, parapharyngeal abscess\" and enrolled 10 cases. Then we summarized the clinical characteristics and treatment. We analyzed and summarized the 10
case reports, in which the number of male was 7. Among them, there were 4 pediatric, and 6 adults were enrolled overall. Most of the symptoms were neck swelling, and the diseased blood vessel was mainly the right internal carotid artery which accounted for half overall. All the patients underwent surgical intervention, and recovered well. So we draw the conclusion that the clinical incidence of cervical pseudoaneurysms is low and can be caused by a variety of factors, especially caused by infectious factors. When a patient has a progressive pulsating mass in the neck, the preliminary diagnosis should be made by ultrasound as soon as possible, and the aortic enhancement CT should be used to further confirm.For a patient with cervical pseudo-aneurysms caused by parapharyngeal infections, he should take operation timely combined with antibiotic treatment in time.