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1.
Pan Afr Med J ; 38: 135, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33912305

RESUMO

Vacuum-assisted breast biopsy (VABB) is a minimally invasive procedure and has become an important treatment method. Although VABB is a minimally invasive procedure, it might cause complications, particularly those associated with blood vessels. In this article, we aimed to describe a 35-year-old female who experienced pseudoaneurysm post-VABB and was successfully treated with embolization. She presented to the hospital with a suspected left breast tumor. The pathology report after biopsy confirmed fibroadenoma, and the patient underwent VABB to remove the tumor. One hour after VABB, the patient described pain and swelling at the location of the removed tumor. Breast ultrasound revealed a hematoma and pseudoaneurysm. The bleeding did not stop following the application of manual compression. Breast hemorrhage was controlled by endovascular embolization. Pseudoaneurysm is an uncommon complication of VABB, and embolization represents an effective method for the management of breast pseudoaneurysm.


Assuntos
Falso Aneurisma/terapia , Neoplasias da Mama/diagnóstico , Embolização Terapêutica/métodos , Hemorragia/terapia , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Biópsia/efeitos adversos , Biópsia/métodos , Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/etiologia , Doenças Mamárias/terapia , Feminino , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/terapia , Hemorragia/etiologia , Humanos , Ultrassonografia Mamária
2.
J Am Vet Med Assoc ; 258(6): 654-660, 2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33683965

RESUMO

OBJECTIVE: To characterize the clinical features, treatment, and outcome of aural hematomas in horses. ANIMALS: 7 horses with 1 or 2 aural hematomas (8 ears in total) treated at a veterinary teaching hospital in 2008 through 2019. PROCEDURES: Data retrieved from medical records included signalment, pertinent historical information, clinical signs, diagnostic procedures (including dermatologic assessment), and treatments. Case outcome was determined from documentation in the medical record or via telephone communication with owners or referring veterinarians. RESULTS: 3 horses were presented after recurrence of aural hematoma following treatment by the referring veterinarian. Four horses had a history of allergic skin disease prior to aural hematoma development. Most (6/7) horses were unilaterally affected. Diagnostic assessments included otoscopic evaluation (3 horses), ultrasonography (3 horses), cytologic examination of ear canal swab samples (3 horses), and histologic examination of a pinnal biopsy specimen (1 horse). Of the 8 pinnae, 2 were treated by nonsurgical needle drainage (1 with concurrent corticosteroid injection) and the remaining 6 underwent surgical incision and placement of compressive sutures. Follow-up information was available for 6 horses, and all affected pinnae were fibrotic with 4 horses having permanent drooping of the pinna. One horse developed a hematoma in the contralateral pinna 1 year after hospital discharge. CONCLUSIONS AND CLINICAL RELEVANCE: Equine aural hematoma is a rare condition. The main principle of treatment is drainage, and treatment options commonly used in small animal practice can be successfully applied in horses. Permanent changes in the cosmetic appearance of the pinna are likely to develop owing to secondary fibrosis.


Assuntos
Otopatias , Doenças dos Cavalos , Animais , Otopatias/diagnóstico , Otopatias/terapia , Otopatias/veterinária , Hematoma/etiologia , Hematoma/terapia , Hematoma/veterinária , Doenças dos Cavalos/diagnóstico , Doenças dos Cavalos/terapia , Cavalos , Hospitais Veterinários , Hospitais de Ensino , Recidiva Local de Neoplasia/veterinária , Estudos Retrospectivos , Resultado do Tratamento
3.
J Card Surg ; 36(4): 1209-1218, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33462880

RESUMO

OBJECTIVES: We aimed to summarize the clinical presentations, therapeutic approaches, and outcomes of Type B intramural hematoma (IMHB) patients with and without Type 2 diabetes mellitus (DM). METHODS: Patients with uncomplicated IMHBs were included between January 2016 and January 2018 and divided into two groups according to whether or not they had DM. We also assessed the potential diagnostic value of serum matrix metalloproteinase-9 (MMP-9) level and the association of it with the disease progression of uncomplicated IMHB patients with and without DM. RESULTS: A total of 149 patients were included (DM group [n = 60] and non-DM group [n = 89]). Patients in the non-DM group underwent thoracic endovascular aortic repair treatment more frequently (12% vs 2%, p = .028) and had a higher reintervention rate during the follow-up (9 in 81 patients, 11% vs. 2%, p = .043). There were significant differences between the two groups regarding the aorta-related mortality rate during the acute phase (9% vs. 0%, p = .042) and the all-cause mortality rate (22% vs. 7%, p = .011). Ulcer-like projection (ULP) development (during the acute phase; hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.15-1.79, p = .005), C-reactive protein (CRP) levels (HR, 2.08; 95% CI, 1.91-3.91, p = .003), and MMP-9 levels (HR, 15.77; 95% CI, 6.48-21.62, p < .001) were associated with an elevated risk for aorta-related mortality. CONCLUSIONS: IMHBs with DM have a considerably better prognosis and serum MMP-9 level appear to be a potential biomarker to predict the disease progression. ULP development (during the acute phase) and CRP levels are also associated with an elevated risk for aorta-related mortality.


Assuntos
Doenças da Aorta , Diabetes Mellitus Tipo 2 , Hematoma , Aorta Torácica , Doenças da Aorta/cirurgia , Diabetes Mellitus Tipo 2/complicações , Hematoma/complicações , Hematoma/terapia , Humanos , Estudos Retrospectivos , Fatores de Risco
4.
Ear Nose Throat J ; 100(2_suppl): 148S-151S, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33410706

RESUMO

Patients with severe coronavirus disease 2019 (COVID-19) may have endothelial inflammation, pseudoaneurysm, and an increasing risk of bleeding, especially during surgical procedures. In this article, we reported 2 cases of COVID-19 patients with neck vascular lesions. The first patient had pseudoaneurysm of the cricothyroid artery, which was treated by percutaneous glue injection through ultrasonography guidance. The second patient presented lateral neck hematoma in front of the left superior thyroid artery, which was managed by coil endovascular embolization. In the context of pandemic, the management of vascular lesions may be performed through interventional radiological procedures that may reduce the risk of virus aerosolization and health care provider contamination.


Assuntos
Adesivos/uso terapêutico , Falso Aneurisma/terapia , Embolização Terapêutica/métodos , Hematoma/terapia , Complicações Pós-Operatórias/terapia , Radiologia Intervencionista , Traqueotomia , Idoso , Falso Aneurisma/complicações , Falso Aneurisma/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Cianoacrilatos/uso terapêutico , Procedimentos Endovasculares , Hematoma/complicações , Hematoma/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço , Complicações Pós-Operatórias/diagnóstico por imagem , Glândula Tireoide/irrigação sanguínea , Ultrassonografia
5.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462039

RESUMO

We report the case of a 68-year-old man who was placed on heparin as bridge therapy and subsequently developed an iliacus haematoma with associated femoral nerve palsy. His team involved the orthopaedic surgery team in delayed fashion after his symptom onset. Due to his active medical conditions, he did not undergo surgical decompression of his haematoma until late into his hospital course. Unfortunately, this patient did not regain meaningful function from his femoral nerve deficit. We believe this case highlights the high index of suspicion necessary for making this diagnosis as well as the repercussions of an untimely decompression for this acute, compressive neuropathy. Although we are surgeons and this is a surgical case, we hope to publish this case in a medical journal to raise awareness that surgical decompression does have a role in this diagnosis and should ultimately be pursued early in its course for optimal patient benefit.


Assuntos
Neuropatia Femoral/diagnóstico , Neuropatia Femoral/etiologia , Hematoma/complicações , Hematoma/diagnóstico , Ílio/irrigação sanguínea , Idoso , Neuropatia Femoral/terapia , Hematoma/terapia , Humanos , Masculino
6.
BMJ Case Rep ; 14(1)2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468637

RESUMO

A 26-year-old man presented with a 4-week history of right lower quadrant abdominal pain which was managed conservatively at home with ibuprofen. Three days later, he presented to the emergency department with worsening pain and swelling following an episode of coughing and slipping in the bathroom. Following his admission, CT angiography showed an active bleed into a 4.6×6.7×11 cm right rectus sheath haematoma, just inferior to the umbilicus. The patient was then referred to interventional radiology for an angiogram and coil embolisation. A superselective branch angiogram showed contrast extravasation from a medial branch of the right inferior epigastric artery, successfully embolised without incident.


Assuntos
Transtornos Traumáticos Cumulativos/complicações , Hemorragia Gastrointestinal/etiologia , Hematoma/diagnóstico , Hematoma/etiologia , Reto do Abdome/lesões , Adulto , Embolização Terapêutica , Hematoma/terapia , Humanos , Masculino
7.
Vasc Endovascular Surg ; 55(3): 221-227, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33308092

RESUMO

PURPOSE: Symptomatic rectus muscle sheath hematoma may be the result of bleeding originating from the inferior epigastric artery. We report the technique and the results from a series of consecutive patients treated by transcatheter embolization, evaluating both ipsilateral and contralateral retrograde approaches. METHODS: This was a retrospective study including patients with verified rectus muscle sheath hematoma as a result of active extravasation from the inferior epigastric artery referred for transcatheter embolization. Technical success, clinical success and major complications were calculated. In addition, minor complications, blood transfusions required after a technically successful embolization, length of stay, peri-procedural and 30-day mortality and overall survival at 6 months were obtained. All statistical analysis was performed using SPSS. RESULTS: Twenty-one patients (mean age = 59.67 ± 19.51 years old) were included. The cause of the bleeding in the vast majority was iatrogenic trauma (n = 12/21, 57.14%). Both contralateral (n = 12/21, 57.14%%) and ipsilateral (n = 9/21, 42.86%) retrograde approaches were used. Embolic materials included micro-coils (n = 13/20, 65%), microspheres (PVA) (n = 1/20, 5%), a combination of PVA and micro-coils (n = 5/20, 25%) and gel-foam (n = 1/20, 5%). Overall technical success was 95.2% (n = 20/21) while clinical success was achieved in all but one of the technically successful cases 95% (n = 19/20). One patient died peri-procedurally due to profound hemodynamic shock. There were no other major complications. Additional transfusion was necessary in 7 patients (n = 7/21, 33.33%). There was a significant increase in the hemoglobin levels after the embolization (7.03 ± 1.78 g/dL pre-procedure Vs 10.91 ± 1.7 g/dL post-procedure, p = 0.048). The median hospital stay was 8 days. The peri-procedure and 30-day mortality was 4.8% (n = 1/21) and 28.6% (n = 6/21) respectively. The 6-month survival was 61.9% (13/21). CONCLUSION: Percutaneous embolization of the inferior epigastric artery is a minimally invasive method with satisfactory results. Both ipsilateral and contralateral retrograde approaches are feasible.


Assuntos
Cateterismo Periférico , Embolização Terapêutica , Artérias Epigástricas , Hematoma/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Periférico/efeitos adversos , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Artérias Epigástricas/diagnóstico por imagem , Feminino , Hematoma/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculares/diagnóstico por imagem , Doenças Musculares/terapia , Reto do Abdome , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
8.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370948

RESUMO

Visceral artery aneurysms (VAAs) are uncommon with an approximate incidence of 0.01%-0.2%. Gastroduodenal artery (GDA) aneurysm is a rare subtype of these uncommon visceral aneurysms that can be fatal if ruptured. We present a case of a 58-year-old Caucasian woman with a VAA and a large haematoma arising from an actively bleeding GDA. While patients with VAA may remain asymptomatic, with some of the aneurysms found incidentally during imaging, they may also present with abdominal pain, anaemia and possible multiorgan failure which may be fatal.


Assuntos
Dor Abdominal/etiologia , Falso Aneurisma/diagnóstico , Embolização Terapêutica/instrumentação , Hematoma/etiologia , Artéria Hepática/diagnóstico por imagem , Dor Abdominal/terapia , Falso Aneurisma/complicações , Falso Aneurisma/terapia , Angiografia Digital , Feminino , Hematoma/diagnóstico , Hematoma/terapia , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
9.
BMC Infect Dis ; 20(1): 731, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028231

RESUMO

BACKGROUND: The specific clinical feature of tetanus is whole body muscle spasms. These spasms are intensely painful and sometime lead to some injuries. Vertebral fractures have been reported as a common complication of tetanus, however iliopsoas hematoma is a rare complication. We describe a case of iliopsoas hematoma in a tetanus patient who had not been treated with any anticoagulant or antiplatelet agents. CASE PRESENTATION: A 72-year-old female patient was transferred to our hospital 7 days after the onset of tetanus. An iliopsoas hematoma was identified in her right iliopsoas muscle on computed tomography. There was no extravasation; thus, the hematoma improved with conservative therapy. There were no episodes that suggested a bleeding tendency, or no factors associated with hemorrhagic conditions. CONCLUSION: This is the first report of iliopsoas hematoma as a complication in a tetanus patient who did not received anticoagulation therapy. The possibility of IPH as a complication of tetanus should be considered before and during the administration of anticoagulation therapy.


Assuntos
Hematoma/diagnóstico , Tétano/patologia , Idoso , Anticoagulantes/uso terapêutico , Feminino , Hematoma/etiologia , Hematoma/terapia , Humanos , Imunoglobulinas/uso terapêutico , Músculos Psoas/diagnóstico por imagem , Músculos Psoas/patologia , Tétano/complicações , Tétano/tratamento farmacológico , Tomografia Computadorizada por Raios X
11.
Vasc Health Risk Manag ; 16: 203-213, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32606717

RESUMO

Aortic intramural hematoma (AIH) is an entity within the acute aortic syndrome. Combination of a priori probability, clinical history, laboratory blood test and imaging techniques are the basis for diagnosis of AIH. This review is focused on all aspects related to diagnosis of patients with AIH, from clinical to imaging and analytical.


Assuntos
Aorta , Doenças da Aorta/diagnóstico , Hematoma/diagnóstico , Aorta/diagnóstico por imagem , Aorta/patologia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/patologia , Doenças da Aorta/terapia , Biomarcadores/sangue , Biópsia , Diagnóstico Diferencial , Hematoma/diagnóstico por imagem , Hematoma/patologia , Hematoma/terapia , Humanos , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco
15.
Asian Cardiovasc Thorac Ann ; 28(8): 512-519, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32674584

RESUMO

Acute aortic syndrome is a group of interlinked conditions with common presenting symptoms, including aortic dissection, penetrating atherosclerotic ulcer, and intramural hematoma. Pharmacological management of acute aortic syndrome is a growing area, with key themes to address the underlying inflammatory pathways believed to be the cause. Research into interleukins, matrix metalloproteinases, and granulocyte macrophage colony-stimulating factor are just some of the many immunological properties being investigated and translated into medical therapies. Stem cell experiments may indicate further advances in the pathologies of acute aortic syndrome. The study of pharmacogenomics to improve treatment across different genomes is also a novel area outlined in this paper.


Assuntos
Aneurisma Dissecante/terapia , Aneurisma Aórtico/terapia , Hematoma/terapia , Fatores Imunológicos/uso terapêutico , Imunoterapia , Transplante de Células-Tronco , Úlcera/terapia , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/genética , Aneurisma Dissecante/imunologia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/genética , Aneurisma Aórtico/imunologia , Hematoma/diagnóstico por imagem , Hematoma/genética , Hematoma/imunologia , Humanos , Fatores Imunológicos/efeitos adversos , Transplante de Células-Tronco/efeitos adversos , Síndrome , Úlcera/diagnóstico por imagem , Úlcera/genética , Úlcera/imunologia
16.
Ann Vasc Surg ; 69: 62-73, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32561245

RESUMO

BACKGROUND: The aim of the study was to analyze aortic-related outcomes after diagnosis of aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU) from a population-based approach. METHODS: Retrospective review of an incident cohort of AD, IMH, and PAU patients in Olmsted County, Minnesota from 1995 to 2015. Primary end point was aortic death. Secondary end points were subsequent aortic events (aortic intervention, new dissection, or rupture not present at presentation) and first-time diagnosis of an aortic aneurysm. Outcomes were compared with randomly selected population referents matched for age and sex in a 3:1 ratio using Cox proportional hazards regression adjusting for comorbidities. RESULTS: Among 133 patients (77 AD, 21 IMH, and 35 PAU), 57% were males, and mean age was 71.8 years (standard deviation, 14). Median follow-up was 10 years. Of 73 deaths among AD/IMH/PAU patients, 23 (32%) were aortic-related. Estimated freedom from aortic death was 84%, 80%, and 77% at 5, 10, and 15 years. There were no aortic deaths among population referents (adjusted hazard ratio [HR] for aortic death in AD/IMH/PAU, 184.7; 95% confidence interval [95% CI], 10.3-3,299.2; P < 0.001). Fifty (38%) AD/IMH/PAU patients had a subsequent aortic event (aortic intervention, new dissection, or rupture), whereas there were 8 (2%) aortic events among population referents (all elective aneurysm repairs; adjusted HR for any aortic event and aortic intervention in AD/IMH/PAU patients, 33.3; 95% CI, 15.3-72.0; P < 0.001 and 31.5; 95% CI, 14.5-68.4; P < 0.001, respectively). After excluding aortic events/interventions ≤14 days of diagnosis, AD/IMH/PAU patients remained at increased risk of any aortic event (adjusted HR, 10.8; 95% CI, 3.9-29.8; P < 0.001) and aortic intervention (adjusted HR, 9.6; 95% CI, 3.4-26.8; P < 0.001). Among those subjects with available follow-up imaging, the risk of first-time diagnosis of aortic aneurysm was significantly increased for AD/IMH/PAU patients when compared with population referents (adjusted HR, 10.9; 95% CI, 5.4-21.7; P < 0.001 and 8.3; 95% CI, 4.1-16.7; P < 0.001 for thoracic and abdominal aneurysms, respectively) and remained increased when excluding aneurysms that formed within 14 days of AD/IMH/PAU (adjusted HR, 6.2; 95% CI, 1.8-21.1; P = 0.004 and 2.8; 95% CI, 1.0-7.6; P = 0.040 for thoracic and abdominal aneurysms, respectively). CONCLUSIONS: AD/IMH/PAU patients have a substantial risk of aortic death, any aortic event, aortic intervention, and first-time diagnosis of aortic aneurysm that persists even when the acute phase (≤14 days after diagnosis) is uncomplicated. Advances in postdiagnosis treatment are necessary to improve the prognosis in these patients.


Assuntos
Aneurisma Dissecante/epidemiologia , Aneurisma Aórtico/epidemiologia , Doenças da Aorta/epidemiologia , Hematoma/epidemiologia , Úlcera/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/terapia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/mortalidade , Aneurisma Aórtico/terapia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/mortalidade , Doenças da Aorta/terapia , Progressão da Doença , Feminino , Hematoma/diagnóstico por imagem , Hematoma/mortalidade , Hematoma/terapia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Úlcera/diagnóstico por imagem , Úlcera/mortalidade , Úlcera/terapia
17.
J Stroke Cerebrovasc Dis ; 29(8): 104869, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32417244

RESUMO

Delayed intraparenchymal hemorrhage (DIPH) is one of the complications of flow diverter (FD) treatment, however, the mechanism is unclear. We present the case of a 54-year-old woman with a partially thrombosed large internal carotid artery aneurysm. She presented intraparenchymal hemorrhage in the right parietal lobe three days after the successful FD treatment. We performed endoscopic hematoma removal, and then her consciousness disturbance was fully recovered. IMP single-photon emission computed tomography showed significant increase of cerebral blood flow in the right hemisphere. We diagnosed DIPH associated with hyperperfusion after FD treatment. It is necessary to consider that DIPH due to hyperperfusion may occur after FD treatment.


Assuntos
Artéria Carótida Interna , Hemorragia Cerebral/diagnóstico por imagem , Circulação Cerebrovascular , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Hematoma/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/fisiopatologia , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/fisiopatologia , Endoscopia , Feminino , Hematoma/etiologia , Hematoma/fisiopatologia , Hematoma/terapia , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/fisiopatologia , Pessoa de Meia-Idade , Imagem de Perfusão/métodos , Fatores de Tempo , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento
18.
No Shinkei Geka ; 48(5): 407-412, 2020 May.
Artigo em Japonês | MEDLINE | ID: mdl-32434951

RESUMO

Organized hematoma is a rare, non-neoplastic, and hemorrhage-prone condition that requires attention due to the risk of intraoperative bleeding. Preoperative embolization was performed to ensure intraoperative hemorrhage control. Here, we report a case of preoperative embolization of an organized hematoma using a low-concentration of n-butyl-2-cyanoacrylate(NBCA). An 80-year-old male presented with a 2-month history of repeated nasal bleeding and nasal obstruction. Diagnostic imaging revealed a mass measuring 3.7 cm in the right maxillary sinus with thinning of the surrounding bone. This was diagnosed as an organized hematoma with a biopsy. As a preoperative treatment, embolization of the main feeding artery was performed through the external carotid artery, using a low concentration of NBCA(5%). When the NBCA cast had reached the organized hematoma, as observed on plain CT, endoscopic sinus surgery was performed, and the organized hematoma was resected without significant bleeding. Preoperative embolization of the organized hematoma with low-concentration NBCA was useful to prevent heavy intraoperative bleeding.


Assuntos
Embolização Terapêutica , Embucrilato , Idoso de 80 Anos ou mais , Atenção , Hematoma/terapia , Humanos , Masculino , Seio Maxilar , Resultado do Tratamento
19.
J Cardiothorac Surg ; 15(1): 49, 2020 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-32293486

RESUMO

BACKGROUND: Aortic intramural hematoma (IMH) is a subset of acute aortic syndrome, and its prognosis may differ between races. This study aimed to study the prognosis of Chinese type B IMH patients and to find out risk factors. METHODS: A total of 71 type B IMH patients with or without penetrating atherosclerosis ulcer (PAU) administrated in our center between September 2013 and October 2017 were retrospectively studied. Both clinical and imaging data were collected and analyzed. The primary end point was aorta-related death, and the secondary end point was progression, which was defined as enlargement of aorta, increased aortic wall thickness, and aortic dissection or aneurysm formation. Kaplan-Meier survival analysis and Cox regression analysis were used for prognostic analysis. RESULTS: Among these 71 patients, 21 had simple type B IMH, when 50 had type B IMH in association with PAU. Twenty-five patients received optimal medical therapy (OMT) alone, while 46 patients received surgery and OMT. The mean follow-up time was 27.5 ± 13.5 months. For type B IMH patients, association with PAU indicated poor prognosis and required more intensive management (HR = 16.68, 1.96~141.87), while maximum aortic diameter (MAD) was an independent risk factor (HR = 1.096, 1.016~1.182). For patients with PAU-IMH, MAD was an independent risk factor (HR = 1.04, 1.021~1.194), while surgical treatment was independent protective factor (HR = 0.172, 0.042~0.696). CONCLUSION: Association with PAU and MAD were independent risk factors for type B IMH patients. Surgery may improve the outcomes for type B IMH in association with PAU.


Assuntos
Aorta/patologia , Doenças da Aorta/complicações , Aterosclerose/complicações , Hematoma/complicações , Úlcera/complicações , Adulto , Idoso , Aneurisma Dissecante/etiologia , Aorta/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/terapia , Progressão da Doença , Feminino , Hematoma/diagnóstico por imagem , Hematoma/terapia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
20.
BMC Cardiovasc Disord ; 20(1): 162, 2020 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-32252640

RESUMO

BACKGROUND: Aortic intramural hematoma is a life-threatening condition reported with increasing frequency. It can be classified into Stanford type A or B depending on whether the ascending or descending aorta are involved, respectively. However, the onset of acute type A aortic dissection following recovery of type B intramural haematoma is rarely reported. CASE PRESENTATION: We present an uncommon case of acute Stanford type A aortic dissection developing 3 months after recovery of type B IMH in a 47-year-old female. She complained acute chest pain. The operation was successfully done. She was in good condition and asymptomatic at a 3-month follow-up. CONCLUSIONS: Type B intramural haematoma can lead to type A aortic dissection even after totally absorbed and the primary entry has the potential to be located in the ascending aorta. Unsatisfied blood pressure control may be the underlying cause.


Assuntos
Aneurisma Dissecante/etiologia , Aneurisma Aórtico/etiologia , Doenças da Aorta/complicações , Hematoma/complicações , Doença Aguda , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/terapia , Implante de Prótese Vascular , Feminino , Hematoma/diagnóstico por imagem , Hematoma/terapia , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
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