A Case of Type A Aortic Intramural Hematoma Successfully Managed with Medical Therapy

A型主動脈壁內血腫以內科藥物治療成功之病例報告

林文雄(Wen-Hsiung Lin) ； 陳俊延(Chun-Yen Chen) ； 葉宏一(Hung-I Yeh) ； 蔡正河(Cheng-Ho Tsai)

《內科學誌》 17卷1期 (2006/02) Pp. 16-21

https://doi.org/10.6314/JIMT.2006.17(1).03

摘要

主動脈壁內血腫(aortic intramural hematoma; IMH)一直被認定是主動脈剝離的變異型。傳統上A型主動脈壁內血腫(type A IMH)由於容易惡化的特質，普遍認為以早期開刀治療預後為佳。但近年來陸續有研究論文顯示，因為病理機制不同於主動脈剝離，藥物治療亦有不錯的存活率。一位67歲的女性，有近20年的高血壓病史，因急性胸痛併發昏厥而被送至醫院診治。電腦斷層掃描顯示由升主動脈至降主動脈皆有主動脈壁內血腫。因為病患拒絕開刀治療，故給予抗高血壓藥物嚴格控制血壓。經一星期住院治療，患者胸痛情況緩解且無併發症發生，出院後患者定期追蹤至今已七個月。根據近年來研究報告統計顯示，對於初步影像檢查評為低惡化風險的type A IMH患者，只用藥物治療亦可以考慮。

並列摘要

Aortic intramural hematoma (IMH) is a variant of aortic dissection. As with type A dissection, early surgery has been recommended for type A IMH because of the high probability of progression. However, the pathology of IMH is distinct from that of aortic dissection, and there have been recent reports of good in-hospital and long-term survival with medical treatment. A 67-year-old female with a 20-year history of poorly controlled hypertension was admitted with severe retrosternal pain. Computed tomography showed a type A aortic IMH from the ascending aorta to the descending aorta. The patient refused emergency surgery, and so she was treated medically to lower her systolic blood pressure. She remained symptom-free after seven months of follow-up. Medical treatment may be acceptable for type A IMH in patients with a low risk of progression.

並列關鍵字

Aortic disease ； Intramural hematoma ； Aortic dissection