主动脉急症的CT诊断课件

急诊室经常遇到的急性主动脉疾病1ppt精选版急诊室经常遇到的急性主动脉疾病1ppt精选版内容急性主动脉综合征主动脉夹层（AD）—壁内血肿（IMH）—穿透性溃疡（PAU）主动脉瘤

—胸，腹破裂和即将破裂的迹象AcuteAorticSyndrome-AorticDissection(AD)IntramuralHematoma(IMH)PenetratingAtheroscleroticUlcer(PAU)AorticAneurysm–Thoracic,AbdominalRuptureandImpendingRuptureSigns2ppt精选版内容急性主动脉综合征AcuteAorticSyndrom

AORTICDISSECTION主动脉夹层Mostcommoncauseofacuteaorticsyndrome(70%)Anintimaltearwithseparationoftheaorticmediaintotwolayers急性主动脉综合征最常见的原因（70%）主动脉壁内膜被分离成两层3ppt精选版AORTICDISSECTION主动脉夹层MostcClassification分类TypeADissectionTypeBDissection4ppt精选版Classification分类TypeADissecTypeA:>90%diewithin3monthsifnottreated

urgentoperationTypeB:medicationsorinterventionaltreatmentA型：如不紧急手术治疗，三个月内死亡率大于90%；B型：药物或介入治疗60%–70%30%–40%5ppt精选版TypeA:>90%diewithin3monChestRadiographicFindings

胸片表现normalin10-40%widenedmediastinum61.1%displacementofaorticcalcification14.1%abnormalcardiaccontour25.8%正常10-40%纵隔增宽61.1%主动脉钙化14.1%心脏异常轮廓25.8%6ppt精选版ChestRadiographicFindings

胸片

RoleofMDCTangiography

动脉CTA作用(1)Sitesofprimaryentryandre-entry;(2)Intimomedialflap,falseandtruelumen;(3)Extentofthedissection(4)Evidenceofrupture;(5)Involvementoftheaorticbranches;(6)Abdominalaorticbranchpatencyandevidenceofend-organmalperfusion;(7)Morphologyanddiameteroftheaortaalongwiththepatency,sizeandtortuosityoftheiliacandfemoralarteries(usefulforendovasculartreatmentplanning)(1)破裂入口和出口;(2)内膜片，真假腔(3)夹层的程度(4)破裂的证据；

(5)主动脉分支受累；(6)腹主动脉分支通畅和终末器官灌注不良的证据；(7)沿着通畅主动脉的形态和直径，髂动脉和股动脉的大小和扭曲（有助于血管内治疗计划）7ppt精选版RoleofMDCTangiography

动脉CTUnenhancedCT平扫UnenhancedCT:-internaldisplacementofintimalcalcificationsContrast-enhancedCT:

-intimalflapthatseparatesthetruelumenfromthefalselumen

CT平扫—钙化内膜内移增强CT—内膜片分离出真假腔8ppt精选版UnenhancedCT平扫UnenhancedCTClassification：StanfordtypeA9ppt精选版Classification：StanfordtypeStanfordtypeB10ppt精选版StanfordtypeB10ppt精选版FalselumenLargercrosssectionalarea(Pfalse≥Ptrue)Delayedenhancement/thrombosisBeaksign；CobwebsignTruelumen:itscontinuitywithanundissectedportionoftheaortaCobwebsignBeaksign假腔截面积大(假腔≥真腔)延迟强化/血栓形成Beaksign；Cobwebsign真腔:一直延续11ppt精选版FalselumenCobwebsignBeaksigComplicationsofThoracicAD并发症AcuteaorticregurgitationMajorarchvesselobstruction,coronaryarteryinvolvementAorticrupture–pericardium

tamponade,leftpleuralcavity,mediastinum急性主动脉瓣关闭不全主动脉弓阻塞冠状动脉受累主动脉破裂——心包填塞，左胸腔、纵隔12ppt精选版ComplicationsofThoracicAD并发ComplicationsofAbdominalAD并发症MainabdominalarterialbranchinvolvementAorticrupture:hemoperitoneum1主腹动脉分支受累——2主动脉破裂腹腔积血13ppt精选版ComplicationsofAbdominalAD并Malperfusion灌注不良Mortality死亡率:38~50%IncidenceMaincoronaryartery 4.7~7%主冠状动脉Carotid 6.6~28%颈动脉Subclavianartery 5.6~17%锁骨下动脉SMA 2.3~11.9%肠系膜上动脉Renalartery 3.2~12.4%肾动脉Intercostala.forspinalcirculation1.8~6.8%肋间动脉如脊髓循环Iliofemoralartery 13.2~30%髂股动脉14ppt精选版Malperfusion灌注不良Mortality死亡率:BranchVesselObstruction分支血管阻塞StaticOcclusion:IntimalflapentersthebranchvesseloriginThrombusformationinthefalselumenDynamicOcclusion:IntimalflapcoversthevesseloriginlikeacurtainArteryarisingfromthetruelumeniscompromised静态闭塞：内膜片进入分支血管的起始处，血栓形成——在假腔动态闭塞：内膜片像窗帘覆盖血管起始处，起源真腔的动脉受到损害15ppt精选版BranchVesselObstruction分支血管阻Dynamicocclusion:动态闭塞-truelumenresemblesaC-shapedenvelopethatispredominantlyconcavetowardthefalselumen-treatedwithafenestrationprocedureTypesofbranch-vesselocclusion

分支血管闭塞的类型16ppt精选版Dynamicocclusion:动态闭塞TypesofStaticocclusion:静态闭塞-intimalflapintersectsorentersthebranch-vesselorigin-treatedlocallywithanintravascularstentTypesofbranch-vesselocclusion17ppt精选版Staticocclusion:静态闭塞Typesof陷阱PitfallsofMDCTNonECG-gatedCT:motionartifactpericardialrecessmuralthrombusinafusiformaneurysmPeriaorticfibrosisormediastinal,pulmonary,orretroperitonealtumors…PericardialRecess18ppt精选版陷阱PitfallsofMDCTNonECG-gateECG-gatedVs.Non-ECG-gated19ppt精选版ECG-gatedVs.Non-ECG-gatedManagementofacuteaorticdissection20ppt精选版ManagementofacuteaorticdisHowtowritereportExtentofdissectionLocationofintimaltearIdentificationoftrue/falselumenMalperfusion :sidebranchinvolvementAssociatedfindings21ppt精选版HowtowritereportExtentofdINTRAMURALHEMATOMA

壁间血肿Spontaneousruptureofthevasavasoruminthe

aorticwallAbloodcollectionwithintheaorticwallwithrestrictedflow/“dissectionwithrestrictedflow”22ppt精选版INTRAMURALHEMATOMA

壁间血肿SpontaPrecontrastCT,narrowwindow“Hyperattenuatingcrescent”onprecontrastCTNocontrastenhancement,smoothmargin30%rateofprogressiontoovertaorticdissectionAcuteIntramuralHematoma急性壁间血肿

23ppt精选版PrecontrastCT,narrowwindowASubacute

IntramuralHematoma

亚急性壁间血肿SubacuteandchronicIMH(1weekaftertheonsetofsymptoms)Decreasedattenuation(identicaltothatinintraluminalblood)24ppt精选版SubacuteIntramuralHematoma

亚DifferentiationofacuteIMHfrommuralthrombusorthrombosedfalselumenseeninADMuralthrombus:

moreirregularlumen,non-displacedintimalcalcification,morecommoninabdominalaorta,associatedwithaneurysm附壁血栓：更不规则腔，非移位性内膜钙化，更常见于腹主动脉，合并动脉瘤IMHADw/thrombosedfalselumenMuralthrombus25ppt精选版DifferentiationofacuteIMHfADfalselumenthrombosis:multilayeredpatternofincreasingattenuationintimalflap(whenyouscrollupanddown..)RadioGraphics2009;29:791–804AD26ppt精选版ADfalselumenthrombosis:RadNaturalhistoryofIMH10%16-47%20-45%27ppt精选版NaturalhistoryofIMH10%16-47Canresolve：followed2months.28ppt精选版Canresolve：followed2months.(a)UnenhancedaxialCTimage

obtainedatpresentationdepictsatype

Baorticintramuralhematoma(arrow).(b)Contrastenhanced

axialCTimageobtained1

monthlatershowsanenhancingulcerlike

projection(arrow),afindingsuggestive

ofanewintimaltear.(c)Contrastenhanced

axialCTimageobtained2

monthslatershowsovertdissection(arrow).Canprogresstodissectionwithulcerlikeprojectionanddissection…29ppt精选版(a)UnenhancedaxialCTimageCanprogresstofusiformaneurysm…可进展为梭形动脉瘤(a,b)UnenhancedaxialCTimagesobtainedatpresentationdepictatypeBhematoma.(c)Contrast-enhancedaxialCTimageobtained2yearslatershowsafusiformaneurysm

atthesiteoftheinitialaorticintramuralhematoma.30ppt精选版Can(a,b)UnenhancedaxialCT

F/70acutechestandupperbackpain2008-02-18CTAngiography31ppt精选版F/70acutechestanduppObservation

acutechestpain2008-04-26CTAngiography32ppt精选版Observationacutechestpain20DifferentialDiagnosis鉴别诊断PericaridalrecessAortitis:diffuse,circumferentialinvolvementRetroperitonealfibrosisorperiaorticlymphomaThickenedaorticwallenhancesMorecommonlyinvolveabdominalaortaCircumferentialRetroperitonealfibrosisPericardial

Recesspericaridal隐窝主动脉炎：弥漫，环周受累腹膜后纤维化或腹主动脉旁淋巴主动脉壁增厚更常见的涉及腹主动脉环33ppt精选版DifferentialDiagnosis鉴别诊断Peri

F/23palpitation,HA2010-07-07CTAngiography40HU75HUTakayasu’sarteritis34ppt精选版F/23palpitation,HA2010TypeBIMHPrimarilyconservativeSurgeryorstent-graftifrecurring,refractorychestpain,evidenceofincreasingextentanddiameterTypeAIMHEmergencyoperationifthereiscardiactamponade,impendingrupture,orruptureConservativetreatment35ppt精选版TypeBIMH35ppt精选版HowtowritereportExtentofIMH:typeAorBPresence/absenceofPAUorintimaltearIfpresent,locationofPAUorintimaltearSignsofrupture/progression36ppt精选版HowtowritereportExtentofIPENETRATINGAORTICULCER

穿透性溃疡Ulcerationofatheroscleroticplaque-Disruptionoftheaorticmedia-Medialhematomaformation,localized-Potentialforrupture-FalseaneurysmformationMid-thoracicordistaldescendingaortaDefinition:ulcerationofanaorticatheroscleroticplaquepenetratingthroughtheinternalelasticlaminaintothemedia。主动脉粥样斑块溃疡穿透内弹性膜进入管腔37ppt精选版PENETRATINGAORTICULCER

穿透性Plaqueulceration斑块溃疡Adventitialpseudoaneurysm血管外膜假性动脉瘤Transmuralrupture透壁破裂Intimalplaqueulceration内膜斑块溃疡Medialhematoma内侧血肿PenetratingAtheroscleroticUlcer穿透性溃疡38ppt精选版PlaqueAdventitialTransmuralNaturalhistoryofPAUInitialdiameter≥20mmordepth≥10mm39ppt精选版NaturalhistoryofPAUInitialCTFindingsFocalcontrast-material-filledpouchcommunicatingwiththeaorticlumenbutextendingoutwardbeyonditsexpectedaorticwallboundaries40ppt精选版CTFindingsFocalcontrast-mate

M/88acuteLt.chestpain,underlyingAGC2005-05-06ChestCT41ppt精选版M/88acuteLt.chestpain42ppt精选版42ppt精选版DDxofAorticUlcerationAtheromatousUlcerNoextensionbeyondexpectedmarginofaorticwallNohematomaPAUAcute,lifethreateningSometimeswithIMH,hematomaorsofttissueinfiltrationIrregularmarginIMHConcentricallylocatedcollectionofbloodwithinmediasmoothlyADIntimalflapextendsacrossaortaLengthmoreextensive43ppt精选版DDxofAorticUlcerationAthero44ppt精选版44ppt精选版AorticAneurysmThoracicaorticaneurysmPermanentabnormaldilationoftheaorta1.5morethannormaldiameter>5cmindiameterNormalvalue:AscTA<4cm/DescTA<3cmAbdominalaorticaneurysm>3cmindiameter45ppt精选版AorticAneurysm45ppt精选版AorticAneurysmCausesAtherosclerosisMarfan’sAortitisTakayasu’sBehcet’sGiantcellMycoticSyphyliticTraumaticTruevs.pseudoFusiformvs.Saccular46ppt精选版AorticAneurysmCauses46ppt精选版AbdominalAorticAneurysmOpindicationDiameterover5.5cmRapidsizeincrease7mm/6month10mm/1yearAnnualriskofrupture<4cm 0%4-5cm 5%5-6cm 5-10%6-7cm 10-20%7-8cm 20-40%>8cm 40-60%47ppt精选版AbdominalAorticAneurysmOpinImpendingRupturePainGrowing:1cm/6moPerianeurysmal

hemorrhageHyperdensecresentIMHorintrathrombichemorrhageDensityheterogeneityofintramuralthrombiEccentriclumenwiththinwallFocaldiscontinuityofcal.RimRecentlyabruptbreak48ppt精选版ImpendingRupturePain48ppt精选版FindingsofImpendingRuptureIncreasedaneurysmsize

：diameter>7cm+acutesymptoms（TAA>6cm,AAA>7.2cm）Thrombusandcalcifications

:thrombustolumenratiodecreasesasaneurysmincrease；thickcircumferentialthrombusisprotectiveagainstruptureHyperattenuatingcrescentsign:acuteorimpendingrupture(refertoPRECONTRASTCT!)Drapedaortasign:containedrupture49ppt精选版FindingsofImpendingRuptureIFindingsofAneurysmRupture

动脉瘤破裂表现TAA:Hemopericardium,Hemomediastinum,Hemothorax(Lt)—心包、纵膈、胸腔积血Aortobronchial,AortoesophagealfistulaAAA:Retroperitonealhematoma(Periaorticbloodextendingintotheperirenal,pararenalspaceorpsoasmuscles)AortoentericfistulaExtravasation:immediateordelayedfindingsFocaldiscontinuityincircumferentialcalcificationsunstableorrupturedaneurysm50ppt精选版FindingsofAneurysmRupture

动ImpendingRupture先兆破裂M/7051ppt精选版ImpendingRuptureM/7051ppt精选版Aneurysmruptureina65-year-oldman.NonenhancedCTscanshowsarupturedatheroscleroticaneurysmofthedescendingthoracicaorta.Notethehigh-attenuationfluidintheleftpleuralspace,a

findingthatrepresentsacutehemothorax.52ppt精选版Aneurysmruptureina65-year-Aortobronchialfistula主动脉支气管瘘Aortoesophagealfistula食管主动脉瘘53ppt精选版AortobronchialfistulaAortoeso2011-11-07outsideCT

M/73Hemoptysis54ppt精选版2011-11-07outsideCTM/755ppt精选版55ppt精选版56ppt精选版56ppt精选版Aortoentericfistula57ppt精选版Aortoentericfistula57ppt精选版58ppt精选版58ppt精选版InfrarenalAAA59ppt精选版InfrarenalAAA59ppt精选版Hyperdensecrescentrimvs.AcuteIMH

高密度新月形边缘与急性IMHHistologically,hyperdensecrescentrimseenatCTinlargeabdominalaorticaneurysmiscausedbyfreshbloodthatfirstinsinuatesitselfintothemuralthrombusandlaterpenetratesintotheaorticwallIMHiscausedbyhemorrhagewithintheaorticwallAAAismorecommonlyassociatedwithachronicIMHthanwithanacuteorsubacuteoneHyperattenuatingcrescentinassociationwithfusiformaneurysmisdiscordantwithsubacuteoracuteIMH60ppt精选版Hyperdensecrescentrimvs.Ac61ppt精选版61ppt精选版62ppt精选版62ppt精选版Impendingrupture；IncreasedsizeofinfrarenalAAA

6.5cm-->7.1cm.

M/68abdominalpain2008-11-27CTAngiographyImpendingrupture.ContainedrupturecasesIncreasedsizeofinfrarenalAAA

6.5cm-->7.1cm.63ppt精选版Impendingrupture；IncreasedsiHowtowritereportExtentofaneurysmSerialchangeofaneurysm

sizeProximalnecklength(fromleftrenalartery:AAA)FeatureofimpendingruptureAssociatedfindings64ppt精选版HowtowritereportExtentofaInfected(Mycotic)Aneurysm

感染（真菌）动脉瘤mostoftenpseudoaneurysm,pronetorupture(53-75%)endocarditisrelatedsepticemia/directpropagationfromadjacentvertebralOM,renalorpsoasmuscleabscess..Findingssaccularshape,lobularcontours,eccentricthrombusperiaorticinflammation,abscess,andmassperiaorticgasandadjacentvertebralbodyabnormalitiesduetothespreadofinfectionfastexpansionovertime65ppt精选版Infected(Mycotic)Aneurysm

感染66ppt精选版66ppt精选版39067380F/73Forfeverfocusw/u2010-01-28AbdomenCT67ppt精选版39067380F/73ForfeverfocuSUV3.82010-03-11CTAngiography68ppt精选版SUV3.82010-03-11CTAngiograp42231815M/71chestpain2011-09-12outsideChestCT69ppt精选版42231815M/71chestpain2011HU202011-10-13CTAngiography70ppt精选版HU202011-10-13CTAngiographyTraumaticAorticInjury(TAI)

外伤性主动脉损伤SeveredecelerationHighspeedmotorvehicleaccidentFallfromagreatheightImmediatedeathin80-90%Untreated:1%perhourfor48h71ppt精选版TraumaticAorticInjury(TAI)

TwoTheoryShearbtwfixedarch/mobiledescendingaortaOsseouspinchbtwspine/anteriorbonycomplexRadioGraphics1997;2772ppt精选版TwoTheoryShearbtwfixedarchTraumaticAorticInjury73ppt精选版TraumaticAorticInjury73ppt精选74ppt精选版74ppt精选版TraumaticAorticInjury(TAI)

外伤性主动脉损伤MostcommonsitesAorticisthmus(90%)Ascendingaorta(5-10%)Descendingaortaneardiaphragmaticiatus(1-3%)75ppt精选版TraumaticAorticInjury(TAI)

PDAremnant76ppt精选版PDAremnant76ppt精选版Directsign直接征象PseudoaneurysmAbnormalaorticcontourAbruptchangeinaorticcaliberKinkingofaorta(pseudocoarctation)SegmentalocclusionofaortaIntimalflapExtravasationofcontrastagentisrare假性动脉瘤主动脉轮廓异常主动脉管径突变主动脉迂曲（假性狭窄）主动脉段闭塞内膜瓣造影剂外渗是罕见的77ppt精选版Directsign直接征象Pseudoaneurysm假RadioGraphics1997;2778ppt精选版RadioGraphics1997;2778ppt精选版F/71Motorvehicleaccident(1MA)79ppt精选版F/7179ppt精选版2006-03-28chestCT80ppt精选版2006-03-28chestCT80ppt精选版Oneweeklater2006-04-05CTangiographythoracicaorta81ppt精选版Oneweeklater2006-04-05CTan2006-04-06CTangiography3DVR,curvedMPR82ppt精选版2006-04-06CTangiography3DVRadioGraphics2008;155583ppt精选版RadioGraphics2008;155583ppt精选Indirectsign-Lessspecific

间接征象-缺乏特异性MediastinalorretrocruralhematomaNotspecificCanbefrommediastinalvenousbleedingObscurefatplanesurroundingaortaorarchvessels

suspiciousforoccultacuteTAIfurtheraortography84ppt精选版Indirectsign-Lessspecific

间M/40Hoarseness(1MA)85ppt精选版M/4085ppt精选版86ppt精选版86ppt精选版TraumaticAorticInjury87ppt精选版TraumaticAorticInjury87ppt精选88ppt精选版88ppt精选版ReferencesAnesthesiaandPerioperativeCareforAorticSurgery,K.Subramaniametal.(eds.),2011theJournalofThoracicandCardiovascularSurgery,2010,140,S92-97RadioGraphics2010;30:445–460 RadioGraphics2009;29:537–552RadioGraphics2007;27:497–507RadioGraphics2010;30:851–867RadioGraphics2009;29:791–804AsianCardiovascThoracAnn2010;18:456-463Heart2001;85:365–368

89ppt精选版ReferencesAnesthesiaandPerioThankyouforyourattention90ppt精选版Thankyouforyourattention90急诊室经常遇到的急性主动脉疾病91ppt精选版急诊室经常遇到的急性主动脉疾病1ppt精选版内容急性主动脉综合征主动脉夹层（AD）—壁内血肿（IMH）—穿透性溃疡（PAU）主动脉瘤

—胸，腹破裂和即将破裂的迹象AcuteAorticSyndrome-AorticDissection(AD)IntramuralHematoma(IMH)PenetratingAtheroscleroticUlcer(PAU)AorticAneurysm–Thoracic,AbdominalRuptureandImpendingRuptureSigns92ppt精选版内容急性主动脉综合征AcuteAorticSyndrom

AORTICDISSECTION主动脉夹层Mostcommoncauseofacuteaorticsyndrome(70%)Anintimaltearwithseparationoftheaorticmediaintotwolayers急性主动脉综合征最常见的原因（70%）主动脉壁内膜被分离成两层93ppt精选版AORTICDISSECTION主动脉夹层MostcClassification分类TypeADissectionTypeBDissection94ppt精选版Classification分类TypeADissecTypeA:>90%diewithin3monthsifnottreated

urgentoperationTypeB:medicationsorinterventionaltreatmentA型：如不紧急手术治疗，三个月内死亡率大于90%；B型：药物或介入治疗60%–70%30%–40%95ppt精选版TypeA:>90%diewithin3monChestRadiographicFindings

胸片表现normalin10-40%widenedmediastinum61.1%displacementofaorticcalcification14.1%abnormalcardiaccontour25.8%正常10-40%纵隔增宽61.1%主动脉钙化14.1%心脏异常轮廓25.8%96ppt精选版ChestRadiographicFindings

胸片

RoleofMDCTangiography

动脉CTA作用(1)Sitesofprimaryentryandre-entry;(2)Intimomedialflap,falseandtruelumen;(3)Extentofthedissection(4)Evidenceofrupture;(5)Involvementoftheaorticbranches;(6)Abdominalaorticbranchpatencyandevidenceofend-organmalperfusion;(7)Morphologyanddiameteroftheaortaalongwiththepatency,sizeandtortuosityoftheiliacandfemoralarteries(usefulforendovasculartreatmentplanning)(1)破裂入口和出口;(2)内膜片，真假腔(3)夹层的程度(4)破裂的证据；

(5)主动脉分支受累；(6)腹主动脉分支通畅和终末器官灌注不良的证据；(7)沿着通畅主动脉的形态和直径，髂动脉和股动脉的大小和扭曲（有助于血管内治疗计划）97ppt精选版RoleofMDCTangiography

动脉CTUnenhancedCT平扫UnenhancedCT:-internaldisplacementofintimalcalcificationsContrast-enhancedCT:

-intimalflapthatseparatesthetruelumenfromthefalselumen

CT平扫—钙化内膜内移增强CT—内膜片分离出真假腔98ppt精选版UnenhancedCT平扫UnenhancedCTClassification：StanfordtypeA99ppt精选版Classification：StanfordtypeStanfordtypeB100ppt精选版StanfordtypeB10ppt精选版FalselumenLargercrosssectionalarea(Pfalse≥Ptrue)Delayedenhancement/thrombosisBeaksign；CobwebsignTruelumen:itscontinuitywithanundissectedportionoftheaortaCobwebsignBeaksign假腔截面积大(假腔≥真腔)延迟强化/血栓形成Beaksign；Cobwebsign真腔:一直延续101ppt精选版FalselumenCobwebsignBeaksigComplicationsofThoracicAD并发症AcuteaorticregurgitationMajorarchvesselobstruction,coronaryarteryinvolvementAorticrupture–pericardium

tamponade,leftpleuralcavity,mediastinum急性主动脉瓣关闭不全主动脉弓阻塞冠状动脉受累主动脉破裂——心包填塞，左胸腔、纵隔102ppt精选版ComplicationsofThoracicAD并发ComplicationsofAbdominalAD并发症MainabdominalarterialbranchinvolvementAorticrupture:hemoperitoneum1主腹动脉分支受累——2主动脉破裂腹腔积血103ppt精选版ComplicationsofAbdominalAD并Malperfusion灌注不良Mortality死亡率:38~50%IncidenceMaincoronaryartery 4.7~7%主冠状动脉Carotid 6.6~28%颈动脉Subclavianartery 5.6~17%锁骨下动脉SMA 2.3~11.9%肠系膜上动脉Renalartery 3.2~12.4%肾动脉Intercostala.forspinalcirculation1.8~6.8%肋间动脉如脊髓循环Iliofemoralartery 13.2~30%髂股动脉104ppt精选版Malperfusion灌注不良Mortality死亡率:BranchVesselObstruction分支血管阻塞StaticOcclusion:IntimalflapentersthebranchvesseloriginThrombusformationinthefalselumenDynamicOcclusion:IntimalflapcoversthevesseloriginlikeacurtainArteryarisingfromthetruelumeniscompromised静态闭塞：内膜片进入分支血管的起始处，血栓形成——在假腔动态闭塞：内膜片像窗帘覆盖血管起始处，起源真腔的动脉受到损害105ppt精选版BranchVesselObstruction分支血管阻Dynamicocclusion:动态闭塞-truelumenresemblesaC-shapedenvelopethatispredominantlyconcavetowardthefalselumen-treatedwithafenestrationprocedureTypesofbranch-vesselocclusion

分支血管闭塞的类型106ppt精选版Dynamicocclusion:动态闭塞TypesofStaticocclusion:静态闭塞-intimalflapintersectsorentersthebranch-vesselorigin-treatedlocallywithanintravascularstentTypesofbranch-vesselocclusion107ppt精选版Staticocclusion:静态闭塞Typesof陷阱PitfallsofMDCTNonECG-gatedCT:motionartifactpericardialrecessmuralthrombusinafusiformaneurysmPeriaorticfibrosisormediastinal,pulmonary,orretroperitonealtumors…PericardialRecess108ppt精选版陷阱PitfallsofMDCTNonECG-gateECG-gatedVs.Non-ECG-gated109ppt精选版ECG-gatedVs.Non-ECG-gatedManagementofacuteaorticdissection110ppt精选版ManagementofacuteaorticdisHowtowritereportExtentofdissectionLocationofintimaltearIdentificationoftrue/falselumenMalperfusion :sidebranchinvolvementAssociatedfindings111ppt精选版HowtowritereportExtentofdINTRAMURALHEMATOMA

壁间血肿Spontaneousruptureofthevasavasoruminthe

aorticwallAbloodcollectionwithintheaorticwallwithrestrictedflow/“dissectionwithrestrictedflow”112ppt精选版INTRAMURALHEMATOMA

壁间血肿SpontaPrecontrastCT,narrowwindow“Hyperattenuatingcrescent”onprecontrastCTNocontrastenhancement,smoothmargin30%rateofprogressiontoovertaorticdissectionAcuteIntramuralHematoma急性壁间血肿

113ppt精选版PrecontrastCT,narrowwindowASubacute

IntramuralHematoma

亚急性壁间血肿SubacuteandchronicIMH(1weekaftertheonsetofsymptoms)Decreasedattenuation(identicaltothatinintraluminalblood)114ppt精选版SubacuteIntramuralHematoma

亚DifferentiationofacuteIMHfrommuralthrombusorthrombosedfalselumenseeninADMuralthrombus:

moreirregularlumen,non-displacedintimalcalcification,morecommoninabdominalaorta,associatedwithaneurysm附壁血栓：更不规则腔，非移位性内膜钙化，更常见于腹主动脉，合并动脉瘤IMHADw/thrombosedfalselumenMuralthrombus115ppt精选版DifferentiationofacuteIMHfADfalselumenthrombosis:multilayeredpatternofincreasingattenuationintimalflap(whenyouscrollupanddown..)RadioGraphics2009;29:791–804AD116ppt精选版ADfalselumenthrombosis:RadNaturalhistoryofIMH10%16-47%20-45%117ppt精选版NaturalhistoryofIMH10%16-47Canresolve：followed2months.118ppt精选版Canresolve：followed2months.(a)UnenhancedaxialCTimage

obtainedatpresentationdepictsatype

Baorticintramuralhematoma(arrow).(b)Contrastenhanced

axialCTimageobtained1

monthlatershowsanenhancingulcerlike

projection(arrow),afindingsuggestive

ofanewintimaltear.(c)Contrastenhanced

axialCTimageobtained2

monthslatershowsovertdissection(arrow).Canprogresstodissectionwithulcerlikeprojectionanddissection…119ppt精选版(a)UnenhancedaxialCTimageCanprogresstofusiformaneurysm…可进展为梭形动脉瘤(a,b)UnenhancedaxialCTimagesobtainedatpresentationdepictatypeBhematoma.(c)Contrast-enhancedaxialCTimageobtained2yearslatershowsafusiformaneurysm

atthesiteoftheinitialaorticintramuralhematoma.120ppt精选版Can(a,b)UnenhancedaxialCT

F/70acutechestandupperbackpain2008-02-18CTAngiography121ppt精选版F/70acutechestanduppObservation

acutechestpain2008-04-26CTAngiography122ppt精选版Observationacutechestpain20DifferentialDiagnosis鉴别诊断PericaridalrecessAortitis:diffuse,circumferentialinvolvementRetroperitonealfibrosisorperiaorticlymphomaThickenedaorticwallenhancesMorecommonlyinvolveabdominalaortaCircumferentialRetroperitonealfibrosisPericardial

Recesspericaridal隐窝主动脉炎：弥漫，环周受累腹膜后纤维化或腹主动脉旁淋巴主动脉壁增厚更常见的涉及腹主动脉环123ppt精选版DifferentialDiagnosis鉴别诊断Peri

F/23palpitation,HA2010-07-07CTAngiography40HU75HUTakayasu’sarteritis124ppt精选版F/23palpitation,HA2010TypeBIMHPrimarilyconservativeSurgeryorstent-graftifrecurring,refractorychestpain,evidenceofincreasingextentanddiameterTypeAIMHEmergencyoperationifthereiscardiactamponade,impendingrupture,orruptureConservativetreatment125ppt精选版TypeBIMH35ppt精选版HowtowritereportExtentofIMH:typeAorBPresence/absenceofPAUorintimaltearIfpresent,locationofPAUorintimaltearSignsofrupture/progression126ppt精选版HowtowritereportExtentofIPENETRATINGAORTICULCER

穿透性溃疡Ulcerationofatheroscleroticplaque-Disruptionoftheaorticmedia-Medialhematomaformation,localized-Potentialforrupture-FalseaneurysmformationMid-thoracicordistaldescendingaortaDefinition:ulcerationofanaorticatheroscleroticplaquepenetratingthroughtheinternalelasticlaminaintothemedia。主动脉粥样斑块溃疡穿透内弹性膜进入管腔127ppt精选版PENETRATINGAORTICULCER

穿透性Plaqueulceration斑块溃疡Adventitialpseudoaneurysm血管外膜假性动脉瘤Transmuralrupture透壁破裂Intimalplaqueulceration内膜斑块溃疡Medialhematoma内侧血肿PenetratingAtheroscleroticUlcer穿透性溃疡128ppt精选版PlaqueAdventitialTransmuralNaturalhistoryofPAUInitialdiameter≥20mmordepth≥10mm129ppt精选版NaturalhistoryofPAUInitialCTFindingsFocalcontrast-material-filledpouchcommunicatingwiththeaorticlumenbutextendingoutwardbeyonditsexpectedaorticwallboundaries130ppt精选版CTFindingsFocalcontrast-mate

M/88acuteLt.chestpain,underlyingAGC2005-05-06ChestCT131ppt精选版M/88acuteLt.chestpain132ppt精选版42ppt精选版DDxofAorticUlcerationAtheromatousUlcerNoextensionbeyondexpectedmarginofaorticwallNohematomaPAUAcute,lifethreateningSometimeswithIMH,hematomaorsofttissueinfiltrationIrregularmarginIMHConcentricallylocatedcollectionofbloodwithinmediasmoothlyADIntimalflapextendsacrossaortaLengthmoreextensive133ppt精选版DDxofAorticUlcerationAthero134ppt精选版44ppt精选版AorticAneurysmThoracicaorticaneurysmPermanentabnormaldilationoftheaorta1.5morethannormaldiameter>5cmindiameterNormalvalue:AscTA<4cm/DescTA<3cmAbdominalaorticaneurysm>3cmindiameter135ppt精选版AorticAneurysm45ppt精选版AorticAneurysmCausesAtherosclerosisMarfan’sAortitisTakayasu’sBehcet’sGiantcellMycoticSyphyliticTraumaticTruevs.pseudoFusiformvs.Saccular136ppt精选版AorticAneurysmCauses46ppt精选版AbdominalAorticAneurysmOpindicationDiameterover5.5cmRapidsizeincrease7mm/6month10mm/1yearAnnualriskofrupture<4cm 0%4-5cm 5%5-6c