主動(dòng)脈夾層病例報(bào)告英文實(shí)用課件

主動(dòng)脈夾層病例報(bào)告英文Presenthistory:hospital1Consciousnessrecovered(onehourafteradmission)Paroxysmaldullpaininleftshoulderandlowerback.Presenthistoryhospital1

NeurologicalDisorders?Neurologicalexaminationwasnormal.Cerebralcomputedtomography:normalRadiography:hyperosteogeny

lumbarhyperosteogeny?Symptomsrelieved:dischargedOtherwiseNormalPresenthistoryhospital2RenalFailure?Cheststiffness&breathlessLowerlimbedema&oliguriaCreatinine:800mmol/LHemodialysisRelievedPresenthistoryhospital3Cardiomyopathy?Endocarditis？Recurredcheststiffness&breathlessECG:nodaltachycardiaUCG:enlargedheartandaorta,hydropericardium.？？？PresenthistorycometousOnJanuary24th,2012,thepatientcametoourhospital.

previoushistorySmokinganddrinkingCeasedsmokingandabstainedfromalcoholDenieddrugabuseNotawareofanyhereditarydiseaseinhisfamily.

historysummary

Acombinationofdifferentclinicalfindings“Electricshocklike”pain(once)Syncope(once)Cheststiffness&BreathlessRepeatedlowbackpainPittingedemaoflowerextremityMonism主動(dòng)脈夾層病例報(bào)告英文DISCUSSIONIMAGING4mg/L(2400μg/L,normal:<500μg/L)ECG:nodaltachycardiaGeneralexaminationThyroidfunctionFractured&confusedConsciousnessrecoveredCTandMRIofpatientswithsuspectedAADLowerextremityCTangiographyofchestandabdomenSensitivityandspecificityofCTreaching100%AcombinationofdifferentclinicalfindingsDiscussionSummaryNa145mmol/L,Cl111mmol/L,K4.PittingedemaoflowerextremityBP:Left,104/74mmHg;DiscussionTreatmentAnalysispluralismAlgianeurologicalpain？Acutecoronarysyndrome？SyncopeTIA？CerebralInfarction？Oliguria&edemarenalfailure?CheststiffnessandpainACS?PE?Fractured&confusedAnalysismonism？GeneralexaminationVitalSignsBP:Left,104/74mmHg;right,123/77mmHg.waterhammerpulse(+)HeartGrade(Ⅳ/6)sighingdiastolicmurmurataorticvalvearea,whichradiatestowardtheapex.GeneralexaminationAbdomenMild,nonfocalabdominaltendernessLowerextremitydiminishedleftlowerextremitypulses.LABFINDINGSBloodroutineWBC4.74G/L;Hb129g/LBloodbiochemistryNa145mmol/L,Cl111mmol/L,K4.1mmol/L,Glu5mmol/L,Urea5.7mmol/L,Cr107μmol/L,UA482μmol/L;CK121IU/L,CKMB12.4IU/L,LDHL198IU/L;AMY33IU/L,LPS57IU/L,AFP4.8μg/L;ThyroidfunctionT3=1.44nmol/L，T4=102nmol/L，fT3=4.23pmol/L,TSH=3.75mIU/L.OtherwiseNormalLABFINDINGSCoagulationfunctionPT=18S,INR=1.5,

D-Dimer:2.4mg/L(2400μg/L,normal:<500μg/L)ESR:4mm/h.

ImagingfindingsImagingfindingsESR:4mm/h.4mg/L(2400μg/L,normal:<500μg/L)ThyroidfunctionAcuteaorticdissection(AAD)LABFINDINGSHemodialysisNa145mmol/L,Cl111mmol/L,K4.UCG:enlargedheartandaorta,hydropericardium.BloodbiochemistryMAP60to75mmHgKeyinthemanagementofacuteaorticdissectionistomaintainahighlevelofsuspicionforthisdiagnosis.DISCUSSIONIMAGINGDiscussiongeneralBloodroutineNa145mmol/L,Cl111mmol/L,K4.Uptonow,variousnoninvasiveandinvasivediagnosticstepsarerequiredtodiagnoseortoruleoutAADincaseofclinicalsuspicion.myocardialinfarctionSmokinganddrinkingGeneralexaminationImagingfindingsImagingfindingsImagingfindingsImagingfindingsCTangiographyofchestandabdomen

discussionDiscussiongeneralAcuteaorticdissection(AAD)AorticdissectionmaypresentwithavarietyofclinicalmanifestationsDiscussiongeneral75%×Misdiagnosesinclude:myocardialinfarctioncerebralinfarctionDiscussionsymptoms&signsPainless:5%Syncope8%AADshouldbeconsideredinthedifferentialdiagnosisofsyncope,evenintheabsenceofpain.DISCUSSIONsymptoms&signsAADmaymimicanacutecoronarysyndromeDISCUSSIONsymptoms&signsDISCUSSIONIMAGINGUptonow,variousnoninvasiveandinvasivediagnosticstepsarerequiredtodiagnoseortoruleoutAADincaseofclinicalsuspicion.DISCUSSIONIMAGINGCTandMRIofpatientswithsuspectedAADSensitivityandspecificityofCTreaching100%SensitivityofMRIisupto95100%DISCUSSIONimagingUltrasoniccardiograms(UCG)TAS(ultrasoundoftheabdomen)TEE(transesophagealechocardiography)PertinentexaminationsmyocardialinfarctionDiscussiongeneralSyncope(once)1mmol/L,Glu5mmol/L,Urea5.LABFINDINGShistorysummaryDISCUSSIONsymptoms&signsmyocardialinfarctionNa145mmol/L,Cl111mmol/L,K4.ThyroidfunctionAlgianeurologicalpain？Acutecoronarysyndrome？DISCUSSIONIMAGINGImagingfindingsOtherwiseNormalNa145mmol/L,Cl111mmol/L,K4.Fractured&confusedOtherwiseNormalRenalFailure?PertinentexaminationsESR:4mm/h.DISCUSSIONlabDeterminationofDdimerDDimer:2.4mg/L(2400μg/L,normal:<500μg/L)DiscussionTreatmentMedicationMAP60to75mmHgtargetHRaround60bpmBetablockersandnitroprussidesodiumCalciumchannelblockersDiscussionTREATMENTInterventionaltherapeuticmeasuresCardiothoracicSurgeryDISCUSSIONCLASSIFICATIONSDiscussionPrognosisThelongtermfollowupThemortalityrate68%48hrsDiscussionSummaryKeyinthemanagementofacuteaorticdissectionistomaintainahighlevelofsuspicionforthisdiagnosis.DiscussionSummaryRigorousclinicalthinkingPertinentexaminationsAvoidstopgaptreatmentmeasuresAcuteaorticdissection(AAD)right,123/77mmHg.CalciumchannelblockersmyocardialinfarctionNa145mmol/L,Cl111mmol/L,K4.7mmol/L,Cr107μmol/L,UA482μmol/L;CK121IU/L,CKMB12.4I