摘要：
Objective:As one of the imaging manifestation of the intramural aortic hematoma(IMH),the clinical study of the IMH with intramural blood pools was less.The study through comparison of intramural blood pools with ulcer-like projection(ULP) and penetrating atherosclerotic aortic ulcer(PAU),learning these lesion's image features and clinical prognosis.Better of IMH image study performance was identified,and the clinical treatment strategy provides the basis for the selection of.Methods:June 2014 to June 2015,admitted consecutively to our hospital for 123 cases only received conservative treatment by drug with IMH,including 31 cases in first onset of follow-up found aortic intramural hematoma with intramural blood pools for A group,22 cases were found to have aortic intramural hematoma with ulcer-like projections for the control group B,18 cases found IMH with penetrating ulcer as control group C.All patients underwent CTA follow-up.Results:Patients in the IBP group were significantly better than the PAU group and the ULP group,but most of the patients were followed up for 17/31 (55％).Groups between the absorption of hematoma and follow-up complications did not differ significantly.Aortic related complications of aortic dissection (n =1) in 8 patients,tumor like dilatation 6,aortic rupture (n =1) underwent surgery or aortic surgery treatment,the remaining 12 patients (continuous pain n =4,the pathological changes were significantly increased n =3,the number of lesions significantly increased the n =1) underwent surgical treatment.Three groups of patients with an average follow-up period of 12 months,no aortic related death occurred.Conclusion:aortic intramural hematoma with intramural blood pools in the lesion size,depth,number,size of the break withulcer-like projection and penetrating ulcer image science exist obvious differences,clinical prognosis was better than that of ulcer-like projection and penetrating ulcer,but there is still a poor prognosis,clinical should pay attention to.%目的:作为主动脉壁内血肿(IMH)的一种影像学表现形式,IMH合并血管内局限性强化灶(IBP)的临床研究较少,本研究通过对比IMH合并IBP与IMH伴溃疡样凸起(ULP)、穿通性溃疡(PAU)的影像学表现特征及临床预后.更好的对IMH影像学表现进行鉴别,同时对临床治疗策略的选择提供依据.方法:2014年6月至2015年6月,我院连续收治123例仅行药物保守治疗的壁内血肿患者,其中31例于初次发病或随访中发现IMH伴IBP为试验组A,22例发现IMH伴ULP为对照组B,18例发现IMH伴PAU为对照组C.所有患者均进行CTA随访.结果:IBP组患者随访预后明显优于PAU组及ULP组,但大部分病例17/31 (55％)随访进展.各组间血肿吸收情况及随访并发症差异无统计学意义.其中8例患者出现主动脉相关并发症(主动脉夹层1例,瘤样扩张6例,主动脉破裂1例)均接受外科手术,其余12例患者(持续疼痛4例,病变明显增大3例,病变数量明显增多1例)接受外科或腔内治疗.三组患者平均随访时间12个月,无主动脉相关死亡发生.结论:IMH合并IBP在病变大小、深度、数量、破口大小上与ULP及PAU影像学上存在明显差异,临床预后明显优于ULP及PAU,但仍有不良预后的发生,临床应引起重视.
