动脉瘤的认识演示教学.ppt

影像学检查 advantages over aortography : （主动脉血管造影） greater contrast resolution and detects small or delayed differences in the opacification（乳浊状） of true and false channels may be able to detect a thrombosed false lumen despite nonopacification does not require arterial catheterization 影像学检查 Aortography filling of a false channel or channels with or without an intervening intimal flap distortion of the true lumen by either a patent or thrombosed false lumen thickening of the aortic wall by more than 5-6 mm caused by a thrombosed false lumen displaced intimal calcification 影像学检查 disadvantages of aortography: most invasive, most expensive risks of intravenous contrast material inadequate detection of pleural leak 影像学检查 advantages of aortography: accurate for determining the site of the initmal tear and extent of the dissection easily demonstrated aortic regurgitation the only procedure that demonstrates the extent and location of dissection into aortic side branches 影像学检查 Magnetic Resonance Imaging shows the site of intimal tear, type and extent of dissection, presence of aortic insufficiency, and differential flow velocities in the true and false channels and in the aortic side branches advantages: no contrast material, no ionizing radiation, noninvasive 鉴别诊断 Acute myocardial infarction pain is more typically pressurelike but may radiate to the arms or neck pain does not typically migrate over time CK-MB levels are elevated elevation prominent in ECG 鉴别诊断 Pulmonary embolus pain is generally respirophasic hypoxemia secondary to ventilation/perfusion mismatch Pericarditis（心包炎） pain typically changes with position auscultation may reveal a pericardial friction rub EKG is common diagnostic(ST-segment） Case Study 65 yo African American male 3 days of intermittent chest pain Episodes last several hours “Squeezing” pain Radiated to back and left arm Positional Case Study + fevers, chills, weight loss + productive cough + hoarse voice - hemoptysis（咳血）, orthopnea （端坐呼