Atypical Aortic Dissection: A Case Report

主動脈剝離是侵犯主動脈的心血管急症，且大多在急診室被診斷出來。對大多數的急診室而言，螺旋式的電腦斷層是一項不具侵犯性，適時且容易獲得的診斷工具，在面臨懷疑主動脈的病人時可用來作為篩選的工具。雖然大多數的急診醫師能很容易辨識出電腦斷層上典型的特徵：內膜瓣，但很多的個案卻在電腦斷層上呈現非典型的特徵：如壁被血腫。未能辨識出主動脈剝離的非典型特徵將延誤診斷及治療。我們提出一位七十歲男性因主訴左側胸痛至急診就診。主動脈電腦斷層呈現左側肋膜積水但無內膜瓣。在到達急診室16小時後，病人主訴呼吸困難及左側胸悶。胸部X光呈現大量左側肋膜水而縱膈腔被推向右側。插上胸管後在接下來的3小時流出600毫升未凝固的血樣肋膜積水。然而，病人在28小時後突然陷入昏迷且急救無效。我們建議急診醫師為主動脈剝離患者安排電腦斷層檢查時，應先做未注射顯影劑之檢查隨後做注射顯影劑之檢查來診斷出壁內血腫(非典型主動脈剝離)。

關鍵字

主動脈剝離；壁內血腫；非典型電腦斷層特徵

並列摘要

Aortic dissection is a catastrophic cardiovascular event that involves the aorta and is mostly diagnosed in emergency departments. In most emergency departments, helical computed tomography (CT) is a noninvasive, timely, easily available diagnostic tool used for screening patients with suspected aortic dissection. Although the classic CT feature of an intimal flap is easily detected by most emergency physicians, many cases present with atypical CT features such as intramural hematomas. Failure to diagnose atypical features of aortic dissection could lead to a delay in diagnosis and lifesaving therapy. We present a 70-year-old man complaining of dull ache over the left side of his chest. Aortic CT scan revealed pleural effusion without an intimal flap. Sixteen hours after presenting to the emergency department, he complained of dyspnea and left side chest tightness. Chest radiography showed massive left side pleural effusion with the mediastinum shifted to the right. Tube thoracostomy revealed 600 mL uncoagulated bloody pleural effusion over the following 3 hours. However, the man collapsed into a coma suddenly 28 hours later and resuscitaton was unsuccessful. We recommend that emergency physicians use noncontrast-enhanced followed by contrast-enhanced CT to detect intramural hematomas (atypical aortic dissection).

並列關鍵字

aortic dissection ； intramural hematoma ； atypical CT feature

國際替代計量

Atypical Aortic Dissection: A Case Report

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