- 期刊
Transabdominal Sonography in the Diagnosis of Acute Aortic Dissection Involving the Abdominal Aorta
腹部超音波對於侵犯腹部主動脈之急性主動脈剝離診斷之角色
摘要
急性主動脈剝離是一高致命性的疾病。雖然影像學的進步提升了對於此病的診斷，但不時仍有誤診及延遲診斷發生。統計上約有三分之一的急性主動脈剝離會包含到腹部主動脈，但急診醫師對於急性腹痛病人的鑑別診斷卻較少注意到此致命性的疾病。腹部超音波目前廣泛為急診醫師使用在急性腹痛的病人，但卻鮮少有研究來探討腹部超音波對於急性主動脈剝離的診斷。本篇研究主要是嘗試以腹部超音波來診斷侵犯腹部主動脈之急性主動脈剝離，並檢視這種診斷工具的優缺點。 在2001年1月到2004年12月間，共有21位急性腹痛且懷疑為主動脈剝離的患者包含在本研究中。所有的病人都接受了腹部超音波及電腦斷層掃瞄，以檢查是否有主動脈剝離。 21為患者中有4位(19%)是先經由腹部超音波檢查懷疑為腹部主動脈剝離，然後接受電腦斷層掃瞄。17位(81%)是先接受電腦斷層掃瞄診斷為腹部主動脈剝離，然後再接受腹部超音波的檢查。在21位病人中有4位因腸氣、肥胖等因素而無法以超音波清楚檢視主動脈。17位腹部超音波檢查懷疑為主動脈剝離者中有1位在電腦斷層掃瞄檢查時並未發現有主動脈剝離的情形。 因此，電腦斷層是診斷主動脈剝離的主要工具。對於急性腹痛的患者，若接受腹部超音波檢查，醫師應特別注意患者是否有腹部主動脈剝離的情形。若有懷疑此症，應立即安排電腦斷層檢查。
並列摘要
Objective: Despite major advances in imaging techniques, correct diagnosis of acute aortic dissection is frequently missed. Although as many as one-third of acute cases of aortic dissection involve the abdominal aorta, emergency physicians rarely suspect this lethal disease in patients presenting with abdominal pain. Transabdominal sonography is typically employed by emergency physicians, but there are few studies investigating this application in diagnosing acute aortic dissection. Methods: Between January 2001 and December 2004, 21 patients who presented with abdominal pain under suspicion of acute aortic dissection involving the abdominal aorta were enrolled in this study. Each patient underwent CT scanning and transabdominal sonography to identify an intimal flap in the abdominal aortic lumen. Whether a CT scan or transabdominal sonography was employed first depended on emergency physician preference. Result: Of these 21 patients, 4 patients (19%) who presented with abdominal pain were initially diagnosed with acute aortic dissection using transabdominal sonography, and then underwent CT scans. Seventeen patients (81%) underwent CT scans directly under the impression of aortic dissection prior to transabdominal sonography. Examination with transabdominal sonography for all 21 patients did not provide a clear view of the abdominal aorta in 4 patients (19%) due to anatomical limitations. Suspicion of an intimal flap in the abdominal aorta was identified in 17 patients (81%) on transabdominal sonography, but 1 of these 17 patients had no visible intimal flap in the aorta on the CT scan. Conclusion: Transabdominal sonography is convenient in EDs. In patients with abdominal pain, we must emphasize that acute aortic dissection needs to be included in the differential diagnosis of abdominal pain when performing transabdominal sonography.