- 期刊
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Peripheral Vascular Malformations: Experience with 27 Cases with 29 Lesions
週邊血管異常－二十七例經驗
摘要
過去十年間我們收集二十七例週邊血管異常之病例•他們分別做了動脈血管攝影［23例］，傳統靜脈血管攝影［9例］直接穿剌靜脈血管攝影［3例］和電腦斷層掃描［9例］。其中九例動靜脈畸型，二例動靜脈瘻管，四例海綿竇狀血管瘤，一例微血管性血管瘤，一例混合海綿竇狀和微血管性血管瘤，一例海綿竇狀血管瘤合併靜脈瘤，一例海綿竇狀血管瘤和靜脈性血管瘤分別長在不同部位，一例靜脈瘤，七例靜脈性血管瘤。各種放射線檢查分析，動脈血管攝影對動靜脈畸型和動靜脈瘻管是最好的工具，但對靜脈性血管瘤和海綿竇狀血管瘤有高比例偽陰性，結果皆為60%。傳統靜脈血管攝影對海綿竇狀血管瘤和靜脈性血管瘤的診斷有很大的幫忙。對少數靜脈性血管瘤或海綿竇狀血管瘤的診斷做直接穿刺靜脈血管攝影是唯一能看到不正常血管及血流方向的方法。在各種檢查均不易看出的血管性病變，電腦斷層掃描可幫助確定病變的大小範圍。從一般常規攝影及電腦斷層掃描發現鈣化點最常發生在靜脈性血管瘤(50%)其次為海綿竇狀血管瘤(33.3%)和動靜脈畸型(11%)。含微血管性血管瘤成分者的動脈血管攝影可能出現早期擴張性靜回流且動脈分枝的管徑大小正常。海綿竇狀血管瘤和靜脈性血管瘤的靜脈攝影都可出現不正常靜脈性擴張區域(abnormal dilated venous vascular space)，但只有靜脈性血管瘤會出現靜脈幹擴張(dilated venous trunk)。
並列摘要
During the past ten years, 27 cases of peripheral vascular malformations in 14 males and 13 females, aged from 12 to 83 years. Nine of the cases were arteriovenous malformation (AVM), four cases of cavernous hemangiomas, one case of capillary hemangioma, seven cases of venous hemangioma, two cases of arteriovenous fistula (AVF), one case of venous aneurysm, one case of combined cavernous hemangioma and venous aneurysm, one case of mixed capillary and cavernous hemangioma and one case of combined venous and cavernous hemangioma in different locations. Arteriography was performed in 23 cases. Conventional venography was done in nine cases. Nine patients received computed tomography (CT) and three patients underwent direct puncture venography. Arteriography was diagnostic in all cases of AVM and AVF, but had a high false negative rate (60%)in venous hemangioma (3/5) and cavernous hemangioma (3/5). Capillary hemangioma appears as dense tissue staining with normal or minimal engorged caliber of feeding arteries and early dilated draining veins. Conventional venography was performed for diagnosis of venous hemangioma with a true positive rate of 5/6.Direct puncture venogrophy was also useful in diagnosis of venous and cavernous hemangioma. Direct puncture venography was the only diagnostic modality in the few cases of cavernous and venous hemangioma. CT scan examination was a good modality for evaluating location and extension of the vascular lesions, but it can not make differential diagnoses among the vascular malformations. Calcification was found in venous hemangioma, cavernous hemangioma and AVM at 50%, 33.3% and 11% respectively. Abnormal dilated venous space which occurred in cavernous and venous hemangiomas is not specific for diagnosis of venous hemangioma but Phlebectasia is a good diagnostic indicator in venous hemangioma.