- 期刊
Asymmetric Brachial Blood Pressure as an Unusual Presentation of Pseudocoarctation of the Aorta with Giant Aortic Arch Aneurysm
不對稱之上肢血壓為假性主動脈狹窄合併巨大主動脈弓瘤之罕見臨床表現
摘要
主動脈狹窄為次發性高血壓原因之一，通常以不對稱之上下肢血壓表現；然而假性主動脈狹窄則不會於狹窄段有任何壓力差，也說是上下肢血壓相同。我們報告一位52歲男性病患以不對稱之上肢血壓為假性主動脈狹窄合併巨大主動脈弓瘤之罕見臨床表現。病患有高血壓之病史，而且左手臂動脈壓遠低於右側。根據胸部X-光，斷層掃描，心臟超音波及心導管檢查的結果，診斷為假性主動脈狹窄合併巨大主動脈弓瘤。經體外循環手術，巨大主動脈弓瘤被切除並以18-mm之主動脈人工血管取代。依據MEDLINE直到2007年的搜尋，我們相信這是第一個了險隨主動脈狹窄以不對稱之上肢血壓為臨床表現的病例。對於懷疑有高血壓合併主動脈疾病之息者，臨床醫師應有高度的警覺性來測量四肢的血壓。
並列摘要
Coarctation of the aorta, a cause of secondary hypertension, usually presents with asymmetric blood pressure of the upper and lower extremities. However, pseudocoarctation of the aorta does not have pressure gradient cross the stenotic area, so blood pressure is the same over four extremities. We describe a case of pseudocoarctation of the aorta, which presented unusually as a giant aortic arch aneurysm with asymmetric brachial blood pressure in a 52-year-old male. He was hypertensive and had a history of relatively lower blood pressure in his left arm. A diagnosis of pseudocoarctation of the aorta with giant aortic arch aneurysm was made according to the results of chest X-rays, computed tomography, cardiac echocardiography and catheterization. Under cardiopulmonary bypass, the giant aortic arch aneurysm were resected and replaced with an 18-mm woven graft. Based on a MEDLINE search up to 2007, we believe that this is the first reported case of pseudocoarctation of the aorta presenting with asymmetric brachial blood pressure. Physicians should keep in mind that measurement of blood pressure in the four extremities is necessary in all cases of suspected aortic arch disease with hypertension.