Diagnosis of an Aneurysm by Musculoskeletal Ultrasonography: A Case Report

利用肌肉骨骼超音波診斷出動脈瘤：病例報告

伍志揚(Chih-Yang Wu) ； 謝正宜(Jeng-Yi Shieh) ； 王亭貴(Tyng-Guey Wang) ； 陳文翔(Wen-Shiang Chen) ； 王崇禮(Chung-Li Wang) ； 王顏和(Yen-Ho Wang)

《台灣復健醫學雜誌》 35卷3期 (2007/09) Pp. 159-163

https://doi.org/10.6315/2007.35(3)05

摘要

高解析度肌肉骨骼超音波雖已廣泛用於腫塊的鑑別診斷，但第一線即診斷出動脈瘤並不常見。本病例為76歲男性，民國93年7月跌倒後造成左側股骨頸骨折，接受髖關節人工關節置換手術。不慎又於94年12月跌倒撞擊左髖，導致植入體周邊骨折，再次做內因定手術。術後追蹤期間，發現大腿內側有一逐漸變大之深部腫塊，安排超音波檢查。
我們用10MHz線性探頭，只隱約在5云分深處看到模糊的低回音區，改用7.5MHz弧線形探頭，清楚看到5到9公分深處有大片異質回音區，及一個邊緣清楚、圓形、水囊性、低回音腫塊，腫塊深部有後方強化現象。在彩色都卜勒超音波下，可明顯見到腫塊內有紅藍各半邊之渦流訊號且有脈動。血管攝影確定為深股動脈之遠端肌肉分枝有動脈瘤，合併有血液外滲之情形，配合當場動脈栓塞及後續手術清瘡，患者症狀及功能顯著改善。
靈活運用不同頻率、深度、排列的探頭，加上彩色都卜勒超音波，是本例正確診斷及治療成功的最大關鍵。

關鍵字

動脈瘤 ； 軟組織腫塊 ； 肌肉骨骼超音波

並列摘要

High resolution musculoskeletal ultrasonography has been a comprehensive tool for differentiation of soft tissue mass. However, it is not commonly used as a standard examination in the diagnosis of an aneurysm. We present a case of a growing mass in the medial aspect of the left thigh status post internal fixation of periprosthetic fracture. Initial examination with a 10 MHz linear array probe revealed a blurred hypoechoic lesion at a depth of 5 cm. After switching to a 7.5 MHz curve-linear array probe, we found a well-defined, ovoid, hypoechoic cystic lesion with posterior enhancement. In color Doppler mode, a half-blue/half-red swirling signal inside the lesion with pulsation was noted. Angiography showed an aneurysm of the left deep femoral artery with extravasation. After trans-artery embolization and debridement, the symptom of left thigh swelling improved. We conclude that the key to accurate diagnosis of this case is proper application of probes of various array and frequency, and Doppler mode.

並列關鍵字

aneurysm ； soft tissue mass ； musculoskeletal ultrasonography