【自发性升主动脉破裂一例】。

K Yamamoto, T Honma, M Kazurayama, K Kuwano, T Sakamoto, N Kaku, T Fujino, K Yamana, N Aoyagi, K Ooishi
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摘要

我们报告一例罕见的自发性升主动脉破裂,无任何动脉瘤形成或主动脉夹层的证据。一名64岁妇女因严重胸痛急诊入住心内科。尽管静脉注射多巴胺(10微克/千克/分钟),患者面色苍白,收缩压仍为70 mmHg。在良好的医疗控制下,她有两年的高血压病史。入院前没有发现胸部外伤的痕迹。体格检查显示颈静脉扩张及远处心音。胸部x线片显示心脏轮廓增大。心电图未见急性冠脉综合征。心包积液伴漂浮血肿样肿块,经二维超声心动图检查。心包穿刺显示心包积液带血(Ht: 26%)。经主动脉造影诊断为急性主动脉夹层,但未见假腔、动脉瘤形成或造影剂外渗的迹象。尽管进行了持续的心包引流,但她突然失去意识,昏倒死亡。升主动脉纵裂,长5cm。病理检查显示内侧囊性坏死,中膜弹性纤维不规则。内膜未见动脉粥样斑块。自发性主动脉破裂是一种危及生命的疾病,需要紧急手术。(摘要删节250字)
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[A case of spontaneous rupture of the ascending aorta].

We report a rare case of spontaneous rupture of the ascending aorta without any evidence of aneurysm formation or aortic dissection. A woman aged 64 was admitted to our cardiac care unit as an emergency patient with severe chest pain. Her face was pale and systolic blood pressure was 70 mmHg in spite of intravenous administration of dopamine (10 micrograms/kg/min). She had a history of hypertension for two years under good medical control. No trace of the chest trauma was noted before her admission. Physical examination revealed neck vein engorgement and distant heart sounds. Chest X-ray film showed enlargement of the cardiac silhouette. ECG showed no evidence of acute coronary syndrome. Pericardial effusion with a floating hematoma-like mass was detected by 2-dimensional echocardiogram. Pericardiocentesis revealed bloody pericardial fluid (Ht: 26%). Aortagraphy was performed resulting in a clinical diagnosis of acute aortic dissection, but there were no signs of a false lumen, aneurysm formation or extravasation of the contrast medium. Although continuous pericardial drainage was performed, she suddenly lost consciousness, collapsed and died. A longitudinal intimal laceration 5 cm long was observed in the ascending aorta. Pathological examination revealed cystic medial necrosis and irregularity of the elastic fibers in the media. No atheromatous plaque was noted in the intima. Spontaneous rupture of the aorta is a life-threatening condition that requires urgent surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

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