急性主动脉综合征.ppt

ADIMHPAUnTransesophageal echocardiogram of the proximal ascending aorta in long-axis view in a patient with proximal aortic dissection.A,The left atrium(LA)is closest to the transducer.The aortic valve(AV)is seen on the left in this view,with the ascending aorta extending to the right.Within the proximal aorta is an intimal flap(I)that originates just at the level of the sinotubular junction above the right sinus of Valsalva.The true lumen(T)and the false lumen(F)are separated by the intimal flap.B,The addition of color flow Doppler in the same view confirms the presence of two distinct lumina.The true lumen(T)fills completely with brisk blood flow(bright blue color),while at the same time minimal retrograde flow(dark orange)is seen in the false lumen(F)nCross-sectional transesophageal echocardiogram of a descending aortic dissection demonstrating a site of intimal tear.Blood flow(in orange)is evident in the true lumen(T)during systole,while a narrow jet of high-velocity blood(in blue)crosses into the false lumen(F)through a tear in the intimal flap(I).nReformatted left anterior oblique view of a contrast-enhanced CT angiogram of the thoracic aorta(same patient as in Fig.4013)showing aortic dissection of the descending thoracic aorta.The intimal flap originates beyond the left subclavian artery and extends distally well into the abdominal aorta.The true lumen(T)and false lumen(F)are easily distinguished and separated by the dark intimal flap(I).Spin-echo image in type A aortic dissection demonstrates the intimal flap in the aorta(solid arrows)and innominate artery(open arrow).Contrast-enhanced CT scan of the chest at the level of the left ventricle showing an intimal flap separating the contrast-filled true(T)and false(F)lumina of an aortic dissection of the descending thoracic aorta.Aortogram in the left oblique view demonstrating proximal aortic dissection and its associated cardiovascular complications.A,The aortic root is dilated.The true lumen(T)and false lumen(F)are separated by the intimal flap(I),which is faintly visible as a radiolucent line following the contour of the pigtail catheter.The abundance of contrast in the left ventricle(LV)is indicative of significant aortic regurgitation(see Fig.408).B,The true lumen is better opacified than the false lumen,and two planes of the intimal flap can now be distinguished(arrows).The branch vessels are opacified,along with marked narrowing of the right carotid artery(CA),which suggests that its lumen is compromised by the dissection.Intramural hematoma of the descending thoracic aorta.A,An axial CT scan without contrast enhancement demonstrates crescentic thickening of the aortic wall that is of increased density(H),consistent with an intramural hematoma of the aorta.A left pleural effusion(E)is also present.B,Subsequent contrast-enhanced images of the same patient demonstrating a contrast-filled aortic lumen with dark crescentic thickening of the aortic wall(H)that does not enhance,confirming the presence of an intramural hematoma that does not communicate with the aortic lumen.Note that neither the size nor the shape of the aortic lumen is distorted the way it would typically be in the presence of a classic aortic dissection.Thoracic aortogram demonstrating a penetrating atherosclerotic ulcer of the distal end of the descending aorta(arrow).The hematoma of the aortic wall is evident as a localized contrast-filled outpouching of the aorta.The remainder of the aorta is diffusely atherosclerotic