背景:钝性主动脉损伤是一种特殊类型的主动脉疾病。由于发病率低,院前死亡率高,漏诊概率高,及时识别在初次损伤中幸存下来的钝性主动脉损伤患者一直是临床挑战。
方法:我们报告一例创伤性主动脉假性动脉瘤伴右髂动脉夹层动脉瘤,在交通事故3个月后确诊。患者是一名76岁的男性,他在过马路时被一辆快速行驶的四轮机动车撞倒(损坏机制是侧面撞击)。他收到了胸部,头颅计算机断层扫描(CT)和全腹部增强CT在当地医院。图像提示蛛网膜下腔出血,右额顶头皮血肿,右锁骨和第二肋骨骨折,胸前降支主动脉外的块状纵隔阴影(纵隔血肿),肠系膜血管损伤伴血肿形成,骨盆骨折,左骶髂关节半脱位.骨盆骨折用外部支架固定后,他被送到我们医院接受进一步治疗。在我们的医院里,他成功地进行了小肠部分切除和CT引导下左侧骶髂关节螺钉内固定,并返回当地医院接受康复治疗。然而,自从事故发生后,病人一直有轻微的胸痛,没有引起临床医生的重视。康复期间,他的胸痛逐渐加重,在当地医院进行的胸主动脉计算机断层扫描血管造影显示主动脉弓的初始降段有假性动脉瘤。转移到我们医院后,术前评估中偶然发现右髂外动脉夹层动脉瘤。最后,进行血管内支架修复,手术后第10天就出院了.经过4年的随访,未发现明显的内漏。
结论:我们强调急诊创伤中心应考虑严重机动车撞车患者主动脉损伤的可能性,并在必要时重复检查以避免漏诊。
BACKGROUND: Blunt aortic injury is a special type of aortic disease. Due to its low incidence, high prehospital mortality and high probability of leakage diagnosis, the timely identification of patients with blunt aortic injury who survive the initial injury has always been a clinical challenge.
METHODS: We report a case of traumatic aortic pseudoaneurysm with right iliac artery dissection aneurysm that was diagnosed 3 mo after a traffic accident. The patient is a 76-year-old male who was knocked down by a fast-moving four-wheel motor vehicle while crossing the road (the damage mechanism was side impact). He received chest, cranial computed tomography (CT) and whole abdomen enhanced CT in the local hospital. The images suggested subarachnoid hemorrhage, right frontoparietal scalp hematoma, fracture of the right clavicle and second rib, lump-shaped mediastinal shadow outside the anterior descending thoracic aorta (mediastinal hematoma), mesenteric vascular injury with hematoma formation, pelvic fracture, and subluxation of the left sacroiliac joint. After the pelvic fracture was fixed with an external stent, he was sent to our hospital for further treatment. In our hospital, he successfully underwent partial resection of the small intestine and CT-guided screw internal fixation of the left sacroiliac joint and returned to the local hospital for rehabilitation treatment. However, since the accident, the patient has been suffering from mild chest pain, which has not aroused the attention of clinicians. During rehabilitation, his chest pain gradually worsened, and the thoracic aorta computed tomography angiography performed in the local hospital showed a pseudoaneurysm in the initial descending segment of the aortic arch. After transfer to our hospital, a dissecting aneurysm of the right external iliac artery was incidentally found in the preoperative evaluation. Finally, endovascular stent graft repair was performed, and he was discharged on the 10th day after the operation. No obvious endo-leak was found after 4 years of follow-up.
CONCLUSIONS: We highlight that emergency trauma centers should consider the possibility of aortic injury in patients with severe motor vehicle crashes and repeat the examination when necessary to avoid missed diagnoses.