pseudoaneurysm

假性动脉瘤
  • 文章类型: Case Reports
    囊性动脉残端假性动脉瘤(CASP)是一种可能危及生命的疾病,可能与多种病因有关。尤其是由于肝胆手术数量增加导致的医源性因素。大多数患者表现为胆道出血。在这里,我们报告了成功管理的CASP病例,该病例最初抱怨右上腹痛。一名38岁的患者在腹腔镜胆囊切除术(LC)后出现胆管损伤,并通过磁共振胰胆管造影(MRCP)鉴定。稍后,她由于CASP而出现胆道出血,然后通过经动脉栓塞(TAE)治疗。CASP是LC后的罕见并发症,但可能危及生命,术后数月至数年可能出现延迟并发症。临床医生和放射科医生应该意识到这一重要实体及其可变表现,以促进早期治疗。
    Cystic artery stump pseudoaneurysm (CASP) is a potentially life-threatening condition that can be related to multiple etiologies, especially the iatrogenic factor owing to the increased number of hepatobiliary procedures. Most patients present with haemobilia. Here we report a successfully managed case of CASP that initially complained of right upper abdominal pain. A 38-year-old patient developed bile duct injury after laparoscopic cholecystectomy (LC) which was identified by magnetic resonance cholangiopancreatography (MRCP). Later, she developed haemobilia due to CASP which was then treated by trans-arterial embolization (TAE). CASP is a rare complication of post-LC, yet potentially life-threatening, with possible delayed complications occurring months to years after the surgery. Clinicians and radiologists should be aware of this important entity and its variable manifestations to facilitate early treatment.
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  • 文章类型: Case Reports
    在使用分阶段治疗的情况下,在大规模卫生损失的条件下进行诊断和治疗管理有其自己的特点,并且需要多学科方法,需要广泛的专家参与和使用现代技术。在世界文献中,作为枪伤并发症的肝动脉假性动脉瘤的超声诊断和临床过程的来源数量非常有限。
    方法:我们介绍了两名患者在肝脏爆炸伤情况下右肝动脉假性动脉瘤的观察和处理经验:成功解决自发闭塞的例子和由于假性动脉瘤破裂而发生内出血的例子。
    这里介绍的临床病例属于高能武器造成的严重伤害类别,其特征是相互加重的综合征,需要同时治疗几个受损的器官。在严重受伤的患者中使用对比方法需要仪器证明,并且可以使用彩色多普勒程序进行日常超声监测的结果。
    结论:肝动脉假性动脉瘤是严重肝脏创伤和损伤的危险并发症,根据我们的数据,这种情况发生在3·2%的患者中。使用彩色多普勒映射程序进行超声检查的方法可以可视化假性动脉瘤并监测其进展。在II-III级医疗保健(角色II-III)中识别肝动脉假性动脉瘤的患者时,应将其进一步撤离到配备血管内矫正技术的医疗机构。
    UNASSIGNED: The diagnostics and treatment management in conditions of massive sanitary losses with the use of staged treatment have their own specifics and require a multidisciplinary approach with the involvement of a wide range of specialists and the use of modern technologies. The number of sources covering the ultrasound diagnostics and clinical course of hepatic artery pseudoaneurysm as a complication of gunshot wounds is quite limited in world literature.
    METHODS: We present the experience of the observation and management of the right hepatic artery pseudoaneurysm in case of the blast injury of liver in two patients: the example of successful resolution with spontaneous occlusion and the example with the occurrence of internal bleeding as a result of pseudoaneurysm rupture.
    UNASSIGNED: Clinical cases presented here belong to the category of severe injuries caused by high-energy weapons, which are characterized by a syndrome of mutual aggravation and need for simultaneous treatment of several damaged organs. The use of contrast methods in severely injured patients requires instrumental justification, and results of daily ultrasound monitoring with the use of color Doppler program can be the one.
    CONCLUSIONS: Pseudoaneurysm of hepatic arteries is a dangerous complication of severe liver wounds and injuries, which occurs in 3·2 % of patients according to our data. The method of ultrasound examination with the use of color Doppler mapping program allows to visualize pseudoaneurysms and monitor their progress. When identifying patients with pseudoaneurysm of hepatic arteries at the level II-III medical care (Role II-III), their further evacuation should be carried out to medical institutions equipped with endovascular correction technologies.
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  • 文章类型: Case Reports
    左心室假性动脉瘤,急性心肌梗塞的不祥后果,对患者的健康构成重大威胁。及时准确的诊断对于改善患者预后至关重要。本报告描述了诊断左心室假性动脉瘤的影像学发现,强调心脏磁共振成像与其他模式的关键作用。我们介绍了两名有心肌梗塞病史的患者,他们表现为心悸,胸痛,呼吸急促.两名患者的初始2D超声心动图均显示左心室动脉瘤扩张。然后做了心脏核磁共振,确认这两种情况下的诊断。
    A left ventricular pseudoaneurysm, an ominous consequence of acute myocardial infarction, poses a significant threat to patient well-being. Prompt and accurate diagnosis is crucial for improving patient outcomes. This report describes diagnostic imaging findings for identifying left ventricular pseudoaneurysms, emphasizing the critical role of cardiac magnetic resonance imaging alongside other modalities. We present two cases of patients with a history of myocardial infarction who presented with palpitations, chest pain, and shortness of breath. Initial 2D echocardiography in both patients revealed aneurysmal dilation of the left ventricle. Cardiac MRI was then performed, confirming the diagnosis in both cases.
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  • 文章类型: Case Reports
    锁骨下动脉假性动脉瘤很少见,发病率和死亡率高。开放式手术修复的替代方法可以包括血管内修复或超声引导的凝血酶注射。这里,我们描述了一种安全且新颖的技术,该技术通过血管密封封堵锁骨下动脉假性动脉瘤,该技术对凝血酶注射无反应,并且难以进行开放修复。
    Subclavian artery pseudoaneurysms are rare and associated with high morbidity and mortality. Alternative approaches to open surgical repair can include endovascular repair or ultrasound-guided thrombin injection. Here, we describe a safe and novel technique of closure of a subclavian artery pseudoaneurysm with Angio-Seal that was unresponsive to thrombin injection and in a difficult location for open repair.
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  • 文章类型: Case Reports
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  • 文章类型: Journal Article
    主动脉假性动脉瘤是一种包含性破裂,其中大部分主动脉壁被破坏,只留下剩下的壁或外膜的薄薄的边缘来保存血液。这种情况具有破裂和潜在致命并发症的高风险。通常,患者出现胸痛;咯血也可能发生,虽然很少。
    一名64岁男性出现两次咯血,无心血管手术史或外伤史。胸部计算机断层扫描(CT)然后进行主动脉造影显示胸主动脉假性动脉瘤,患者接受了外科主动脉修复术,没有任何并发症。此病例强调了胸主动脉假性动脉瘤的罕见表现。
    咯血是胸主动脉假性动脉瘤的罕见表现,可能是即将破裂的警告信号。咯血可能是由于主动脉肺瘘的形成或假性动脉瘤直接侵蚀肺实质而发生的。
    临床医生必须及早识别此类表现,以便及时诊断和预防并发症。
    结论:认为咯血是胸主动脉假性动脉瘤的表现。由于并发症和死亡率高,早期诊断和治疗至关重要。创伤和心血管手术是胸主动脉假性动脉瘤的最常见原因;然而,有时它可能由于动脉粥样硬化而发生。
    UNASSIGNED: Aortic pseudoaneurysms are a type of contained rupture where most of the aortic wall is breached, leaving only a thin rim of the remaining wall or adventitia to hold the blood. This condition carries a high risk of rupture and potentially fatal complications. Typically, patients present with chest pain; haemoptysis can also occur, though rarely.
    UNASSIGNED: A 64-year-old male who presented with two episodes of haemoptysis, with no history of cardiovascular surgery or trauma. A chest computerized tomography (CT) followed by an aortogram revealed a thoracic aortic pseudoaneurysm and the patient underwent surgical aortic repair without any complications. This case underscores the rare presentation of thoracic aortic pseudoaneurysm.
    UNASSIGNED: Haemoptysis is a rare manifestation of thoracic aorta pseudoaneurysm and can be a warning sign of impending rupture. Haemoptysis may occur due to formation of aortopulmonary fistula or direct erosion of pseudoaneurysm into lung parenchyma.
    UNASSIGNED: It is imperative for clinicians to recognise such manifestations early for prompt diagnosis and prevention of complications.
    CONCLUSIONS: Recognise haemoptysis as the manifestation of thoracic aortic pseudoaneurysm.Early diagnosis and treatment are crucial due to high rate of complications and mortality.Trauma and cardiovascular surgery are the most common cause for thoracic aortic pseudoaneurysm; however, sometimes it can occur due to atherosclerosis.
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  • 文章类型: Journal Article
    儿科人群咯血,虽然不常见,对家庭和医疗保健从业人员提出了重大挑战。咯血的严重程度决定了管理决策。大多数轻度和自限性的病例都是保守治疗。然而,可能发生“危及生命的咯血”,并且被定义为危及气道的任何程度的失血,并且在儿童中被任意认为在24小时内>8ml/kg。它需要及时的气道管理和复苏,然后是由支气管镜检查组成的量身定制的方法,计算机断层扫描(CT),介入放射学,和/或手术取决于患者的临床状态和心肺合并症。支气管动脉在各种情况下都肥大,由于其全身压力水平,咯血占90-95%;其余的由肺动脉病变造成。尽管致病机制相似,小儿咯血的病因与成人不同,急性下呼吸道感染是主要原因。影像学在确定出血的来源和原因中起着至关重要的作用。多探测器计算机断层扫描(MDCT)已成为咯血诊断评估的主要方式,并为潜在的介入程序提供了路线图。本文讨论了咯血的病因,并简要提及了诊断方式。它提供了一个结构化的报告格式,并用它来说明咯血的影像学特征,重点是CT血管造影。肺实质的关键发现,气道,支气管和非支气管全身络脉,并详细阐述了肺动脉。它进一步解决了介入管理的细微差别,特别强调支气管动脉栓塞术和肺动脉栓塞术在儿科人群中的应用。文章还强调了潜在的并发症和影响复发率的因素。
    Hemoptysis in the pediatric population, while infrequent, poses significant challenges for both the family and healthcare practitioners. The severity of hemoptysis dictates management decisions. Most cases being mild and self-limiting are treated conservatively. However, \"life-threatening hemoptysis\" may occur, and is defined as any degree of blood loss that endangers the airway and is arbitrarily considered to be > 8 ml/kg in 24 h in children. It requires prompt airway management and resuscitation followed by a tailored approach consisting of bronchoscopy, computed tomography (CT), interventional radiology, and/or surgery depending on the patient \'s clinical status and cardiopulmonary comorbidities. Bronchial arteries are hypertrophied in myriad conditions and account for 90-95% cases of hemoptysis due to their systemic pressure levels; the rest being contributed by pulmonary artery pathologies. Despite similar pathogenic mechanisms, the etiologies of pediatric hemoptysis differ from those in adults, with acute lower respiratory tract infections being the predominant cause. Imaging plays a crucial role in identifying the source and cause of hemorrhage. Multidetector computed tomography (MDCT) has emerged as a prime modality in the diagnostic evaluation of hemoptysis and provides a roadmap for potential interventional procedures. This article discusses the etiopathogenesis of hemoptysis along with a brief mention of the diagnostic modalities. It provides a structured reporting format and uses it to illustrate the imaging features in hemoptysis, with emphasis on CT angiography. The key findings in the lung parenchyma, airways, bronchial and non-bronchial systemic collaterals, and pulmonary arteries are elaborated upon. It further addresses the nuances of interventional management, particularly emphasizing the applications of bronchial artery embolization and pulmonary artery embolization in the pediatric population. The article also underscores the potential complications and factors influencing recurrence rates.
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  • 文章类型: Journal Article
    背景:周围性动脉瘤,虽然已经知道了几个世纪,由于它们的无症状性质,监测是具有挑战性的。先进的成像改进了检测,这对于预防紧急并发症至关重要。这项为期五年的回顾性研究来自单个中心,旨在评估位置,介绍,诊断,110例股动脉和下肢动脉动脉瘤的治疗。材料和方法:该研究包括2018-2023年间治疗的71例真实动脉瘤和39例假性动脉瘤患者。治疗方法根据动脉瘤大小,动脉粥样硬化的严重程度,和操作风险。该研究评估了患者的人口统计学,手术细节,术后并发症,和动脉瘤的特点。结果:急性肢体缺血在真实动脉瘤中更为普遍(25.4%vs.7.7%;p=0.02)。在假性动脉瘤中进行动脉瘤切除术的频率更高(87.2%vs.54.9%;p<0.001),而血管内治疗和手术旁路术在真正的动脉瘤中更为常见(血管内:22.5%vs.2.6%;p=0.01;旁路:21.1%vs.0%;p<0.001)。术后早期并发症发生率为22.7%。12个月的再手术自由(73.7%vs.87%;p=0.07),截肢(97.7%vs.93.8%;p=0.2),和移植物狭窄(78.7%vs.86.87%;p=0.06)显示两组之间没有显着差异。结论:下肢动脉瘤常表现为非特异性症状,导致晚期诊断和危及生命的并发症。开放和血管内治疗都是可行的,尽管对于假性动脉瘤还需要更多的研究.由于潜在的不良事件,警惕的随访至关重要,尽管总体死亡率和发病率仍然很低。
    Background: Peripheral aneurysms, although known about for centuries, are challenging to monitor due to their asymptomatic nature. Advanced imaging has improved detection, which is crucial for preventing emergent complications. This five-year retrospective study from a single center aimed to evaluate the location, presentation, diagnosis, and management of 110 patients with aneurysms of the femoral and popliteal arteries of the lower limb. Materials and methods: The study included 71 true aneurysms and 39 pseudoaneurysms patients treated between 2018-2023. Treatment methods were based on aneurysm size, atherosclerosis severity, and operation risk. The study assessed patient demographics, surgical details, postoperative complications, and aneurysm characteristics. Results: Acute limb ischemia was more prevalent in true aneurysms (25.4% vs. 7.7%; p = 0.02). Aneurysmectomy was performed more frequently in pseudoaneurysms (87.2% vs. 54.9%; p < 0.001), while endovascular treatment and surgical bypass were more common in true aneurysms (Endovascular: 22.5% vs. 2.6%; p = 0.01; bypass: 21.1% vs. 0%; p < 0.001). Early postoperative complications occurred in 22.7% of patients. The 12-month freedom from reoperations (73.7% vs. 87%; p = 0.07), amputations (97.7% vs. 93.8%; p = 0.2), and graft stenosis (78.7% vs. 86.87%; p = 0.06) showed no significant differences between groups. Conclusions: Lower limb aneurysms often present with non-specific symptoms, leading to late diagnosis and life-threatening complications. Both open and endovascular treatments are feasible, though more research is needed for pseudoaneurysms. Vigilant follow-up is crucial due to potential adverse events, though overall mortality and morbidity remain low.
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  • 文章类型: Journal Article
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  • 文章类型: Case Reports
    内镜逆行胰胆管造影(ERCP)仍然是治疗胆总管(CBD)结石和狭窄扩张的主要治疗方式。它还具有多种诊断作用,包括刷活检。该过程仍然与副作用以及增加的发病率和死亡率相关。副作用之一是出血。这可能与创伤后假性动脉瘤延迟性出血后的手术创伤或出血有关。尽管可能有人认为胆管周围的炎症,特别是胰腺周围的炎症也可能导致壶腹区域的延迟出血,我们介绍了一例延迟性假性动脉瘤出血病例,该病例在ERCP后通过介入放射学引导栓塞治疗成功.
    Endoscopic retrograde cholangiopancreatography (ERCP) remains the main therapeutic modality towards the management of common bile duct (CBD) stones and dilatation of strictures. It also has varied diagnostic roles including brush biopsy. The procedure still is associated with side effects and increased morbidity and mortality. One side effect is bleeding. This may be associated with procedural trauma or bleeding following post-traumatic pseudoaneurysm delayed-onset bleeding. Although it may be argued that inflammation surrounding the biliary duct area and in particular the pancreas could also contribute to the delayed bleeding along the ampullary region, we present a case of delayed pseudoaneurysm bleeding that was successfully managed post-ERCP via interventional radiology-guided embolization.
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