ISSN 1004-4140
    CN 11-3017/P

    肺动脉夹层的病因分类及CT表现

    Etiological Classification and Computed Tomography Features of Pulmonary Artery Dissection

    • 摘要: 目的:探讨肺动脉夹层的病因分类及CT表现,并分析不同影像表现与死亡的相关性。方法:回顾性分析2006年7月至2024年12月确诊的37例肺动脉夹层患者的临床资料及CT表现。结果:本研究共纳入了37例肺动脉夹层病例,肺动脉高压相关肺动脉夹层6例,平均年龄37.00±11.22岁。主动脉夹层相关肺动脉夹层31例,其中主动脉Stanford A型夹层30例,Stanford B型夹层1例,平均年龄58.10±11.26岁,其中死亡9例。肺动脉高压相关肺动脉夹层均出现主肺动脉增宽征象,均值约50.67±15.17 mm,右室壁均有增厚。主动脉夹层相关肺动脉夹层12例破裂位于升主动脉后壁,14例破口显示不清;肺动脉壁内血肿1类18例,2类10例,3类3例。其他影像学表现还包括肺动脉狭窄(9例)及心包积血(24例)。不同影像学表现之间的死亡率无显著差异。结论:肺动脉高压相关及主动脉夹层是肺动脉夹层最为相关的两种病因,其中主动脉夹层相关肺动脉夹层容易被漏诊而低估。充分理解肺动脉夹层的病理生理机制并掌握CT表现,能够及时准确地做出诊断并制定合理的干预措施。

       

      Abstract: Objective: To characterize the etiological classification and computed tomography (CT) features of pulmonary artery dissection (PAD), and to evaluate the association between distinct imaging findings and mortality. Methods: The clinical data and CT imaging features of 37 patients with confirmed PAD diagnosed between July 2006 and December 2024 were retrospectively analyzed. Results: Among the 37 patients, six had pulmonary hypertension (PH)-associated PAD (mean age: 37.0±11.2 years), all of whom had main pulmonary artery dilation (mean diameter: 50.7±15.2 mm) and right ventricular wall thickening. The remaining 31 patients had aortic dissection (AD)-associated PAD (mean age: 58.1±11.3 years), comprising 30 Stanford Type A and one Type B; nine patients (29.0%) in this subgroup died. Within the AD-associated PAD group, the intimal tear was localized to the posterior wall of the ascending aorta in 12 patients, and the entry site was indeterminate in 14 patients. Pulmonary artery intramural hematoma was classified as Category 1 (n=18), Category 2 (n=10), or Category 3 (n=3). Additional imaging findings across the cohort included pulmonary artery stenosis in nine patients and hemopericardium in 24. There were no significant differences in mortality across different imaging findings. Conclusion: PH and AD are the two predominant etiologies of PAD. Notably, AD-associated PAD is frequently underdiagnosed and clinically underestimated. A comprehensive understanding of its pathophysiological mechanisms and characteristic CT patterns is essential for prompt diagnosis and optimal therapeutic decision-making.

       

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