急性主动脉综合征必威体育精装版.ppt

AD各种影像技术诊断效用分析影像诊断类型内破口真假腔分支受累AR出血排除夹层范围定位血栓外渗MRI++++++++~++++++++~+++++++++CT+++++~++++~+++++++—++~+++Echo++~+++++++++—~++++—Angio++++++++++++++++++++~+++01020304主要原因之一。MRA和CTA检查中经常能发现纵隔和胸膜腔积液。夹层进行性外渗常常是其破裂的预兆，也是急诊行手术或腔内隔绝夹层外渗导致的心包腔积液是急性AD死亡的05术的主要指征。确定有无AD外渗和破裂预兆：Transesophagealechocardiogramoftheproximalascendingaortainlong-axisviewinapatientwithproximalaorticdissection.A,Theleftatrium(LA)isclosesttothetransducer.Theaorticvalve(AV)isseenontheleftinthisview,withtheascendingaortaextendingtotheright.Withintheproximalaortaisanintimalflap(I)thatoriginatesjustatthelevelofthesinotubularjunctionabovetherightsinusofValsalva.Thetruelumen(T)andthefalselumen(F)areseparatedbytheintimalflap.B,TheadditionofcolorflowDopplerinthesameviewconfirmsthepresenceoftwodistinctlumina.Thetruelumen(T)fillscompletelywithbriskbloodflow(brightbluecolor),whileatthesametimeminimalretrogradeflow(darkorange)isseeninthefalselumen(F)Cross-sectionaltransesophagealechocardiogramofadescendingaorticdissectiondemonstratingasiteofintimaltear.Bloodflow(inorange)isevidentinthetruelumen(T)duringsystole,whileanarrowjetofhigh-velocityblood(inblue)crossesintothefalselumen(F)throughatearintheintimalflap(I).Reformattedleftanteriorobliqueviewofacontrast-enhancedCTangiogramofthethoracicaorta(samepatientasinFig.40–13)showingaorticdissectionofthedescendingthoracicaorta.Theintimalflaporiginatesbeyondtheleftsubclavianarteryandextendsdistallywellintotheabdominalaorta.Thetruelumen(T)andfalselumen(F)aree