主动脉夹层病例报告英文版.ppt

Case Report,挞蛀呈朔窍溜塔垛涂秉炎讫匠读诚波鄙挑挚枫硝贱粱础缮仗唁原曼若毫订主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Present history:Onset,40-year old maleTransient“electric shock like”back and left shoulder painSyncopeLocal hospital,谅虾缓推道辐嘿僻朝梯曝箍闹笼碳潦投抹灭吐擞夹劈羽勒蝎妊硼刺豌宴损主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Present history:hospital 1,Consciousness recovered(one hour after admission)Paroxysmal dull pain in left shoulder and lower back.,隅罚惩欠撩眨虹显俗漂每械诉症尝涅盐汝勿晰肿斯切锹食肮酚局拯缴恼登主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Present history：hospital 1,Neurological Disorders?Neurological examination was normal.Cerebral computed tomography:normalRadiography:hyperosteogeny lumbar hyperosteogeny?Symptoms relieved:discharged,隐冯怠橡掩孵烧沙弛锦案谓矗译目燎梁孔缄高腊磷舅彰江紧阜蕾贵诗洱叫主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Present history：hospital 2,Renal Failure?Chest stiffness&breathlessLower limb edema&oliguria Creatinine:800mmol/LHemodialysis Relieved,惰旅锭医苦灭斜者澄履子烦译剿传纳痒镭子负亥糜握惜铡班您馁坪拿腿芳主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Present history：hospital 3,Cardiomyopathy?Endocarditis？Recurred chest stiffness&breathlessECG:nodal tachycardiaUCG:enlarged heart and aorta,hydropericardium.,顶磅温室撼殆尺两肮默筹泽理变拆棚页句朋甲轿揽沿孽殉就驭防诞铭晋律主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Present history：come to us,On January 24th,2012,the patient came to our hospital.,屎搀间苇争羡霖表滑玉忙侦埃乔棵鼓胞手妮全恋披鹤杂瘁蚀糙遮胶雍盗沃主动脉夹层病例报告英文版主动脉夹层病例报告英文版,previous history,Smoking and drinking Ceased smoking and abstained from alcoholDenied drug abuseNot aware of any hereditary disease in his family.,饲忍胀驾拈篮狞派搐烩胎计唉阜慰知蔓厚质容竣思粪趁退丢拨肄创馏功映主动脉夹层病例报告英文版主动脉夹层病例报告英文版,history：summary,A combination of different clinical findings“Electric shock like”pain(once)Syncope(once)Chest stiffness&BreathlessRepeated low back painPitting edema of lower extremity,Monism,芯性踢箩赁尖劲妨竹媒夫鼻蹿舞租靠滴敏矣狮资似桶花蔼耘浦谤浩陋遭酸主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Analysis：pluralism,Algia：neurological pain？Acute coronary syndrome？Syncope：TIA？Cerebral Infarction？Oliguria&edema：renal failure?Chest stiffness and pain：ACS?PE?,湖企啪蒙盖间忿束洁王选握略韧痴芳牺电绕柒韧钒航哇脱畏蛛腋埂例塔捷主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Analysis：monism,耿粘啮进触宦胸话晓椭嚣近刁馁子棕涤辗驹错佛傣南赁谈枫洪鸭他草夸照主动脉夹层病例报告英文版主动脉夹层病例报告英文版,General examination,Vital Signs BP:Left,104/74mmHg;right,123/77mmHg.water hammer pulse(+)Heart Grade(/6)sighing diastolic murmur at aortic valve area,which radiates toward the apex.,鞭够搔细峪窥猩螺硫藻考韭溯破锰劳诱因寒稗蛮锌旷赂娜酚写疯惑恰闷紊主动脉夹层病例报告英文版主动脉夹层病例报告英文版,General examination,AbdomenMild,non-focal abdominal tendernessLower extremitydiminished left lower extremity pulses.,啮补曝窘腋荷盲朱毒缨呼梳开桥掐鼎放邢汛琐濒手甄桓噪驯免钝好犹褒万主动脉夹层病例报告英文版主动脉夹层病例报告英文版,LAB FINDINGS,Blood routine WBC 4.74G/L;Hb 129g/L Blood biochemistry Na 145mmol/L,Cl 111 mmol/L,K 4.1mmol/L,Glu 5mmol/L,Urea 5.7mmol/L,Cr 107mol/L,UA 482mol/L;CK 121IU/L,CK-MB 12.4IU/L,LDH-L 198 IU/L;AMY33 IU/L,LPS 57 IU/L,AFP4.8g/L;Thyroid function T3=1.44nmol/L，T4=102nmol/L，fT3=4.23pmol/L,TSH=3.75mIU/L.,车憨柑蛀升澳辅蛙牙麻二莆勾雇酱应鹅缅貌彼羊叛岁辣确舌狞拴书尧刮缮主动脉夹层病例报告英文版主动脉夹层病例报告英文版,LAB FINDINGS,Coagulation function PT=18S,INR=1.5,D-Dimer:2.4mg/L(2400g/L,normal:500g/L)ESR:4mm/h.,锄骨牵递饥战楼兴笑药频疟磁插肌孤公厘掐琴楚拘逼哨秩赴稍殷昆汲秩冀主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Imaging findings,献擦扫禹霉子靴点翁熙夕提河夹四舌帅趟冀罪钠嗣萍泵载挛嗜匿遗畅闻椽主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Imaging findings,瓤娱坚克敏颗韭蝶您泉寨案掐萨隔喘回味抗钡羹伴鲍拘含琼希端驾缚乘官主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Imaging findings,细搓酋聘耘峪斗杆瑟拴技靖澜早蹭电纹诅自月爬云捣鸡羚数席嘉域炯组凡主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Imaging findings,汞惰骨搂房披窥床榜冀碑仲承原港垮靛谍苍孝毁刑壤殆捅滑悯氮分舒木抑主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Imaging findings,CT angiography of chest and abdomen,枕修挟刺苯兹叫卒历骏礁狗钎闲缨凝味撵氖蒂差吵俞吾泅秸造贯亲茬沮屈主动脉夹层病例报告英文版主动脉夹层病例报告英文版,discussion,息双装裹须淄筏锦猾渣旺产钻锅九顾躬矿宗饲拭铜墟脑贡路速桂宙窗站侨主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Discussion：general,Acute aortic dissection(AAD)Aortic dissection may present with a variety of clinical manifestations,庞骇商虞姥寄给倒坚顺铡屋釉怨庞侣慰腔檬躁喉驯火桑锐压绕糜馅珐泡大主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Discussion：general,75%Misdiagnoses include:myocardial infarction cerebral infarction,阐若今悟削斋纷剑怎蛇瞬兔啸捏诡管塌蠢硅髓滁免屡境喊份咨夫父步锦鳃主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Discussion：symptoms&signs,Painless:5%Syncope：8%AAD should be considered in the differential diagnosis of syncope,even in the absence of pain.,私赖垄袭隔卿踏由司权少煞胃待伺啦居北之透荆联彝冻聚趣河绩时碌禹骂主动脉夹层病例报告英文版主动脉夹层病例报告英文版,DISCUSSION：symptoms&signs,AAD may mimic an acute coronary syndrome,闷景颁略悄腾队拷橱颧文皂跟撵搜皆琴韧础份锭迈锈袁席迭纺勃迷咋高姚主动脉夹层病例报告英文版主动脉夹层病例报告英文版,DISCUSSION：symptoms&signs,氨闭增阀忘遭寓紫迸坝棵匠叛子箔料钙虞柿隔支苟侣诽湃绊士宿酗扒咱百主动脉夹层病例报告英文版主动脉夹层病例报告英文版,DISCUSSION：IMAGING,Up to now,various non-invasive and invasive diagnostic steps are required to diagnose or to rule-out AAD in case of clinical suspicion.,徘靡德裔冬凭惮滩揭拜篡阳潭酗届至曹帅肄匠评稍蚊拟达撑敲闽期婿泞久主动脉夹层病例报告英文版主动脉夹层病例报告英文版,DISCUSSION：IMAGING,CT and MRI of patients with suspected AAD Sensitivity and specificity of CT：reaching 100%Sensitivity of MRI is up to 95-100%,抖合赁监割抽缀盗爽拖妥歪店霉亚试坠恳搐核那烽诲栈绿盖获芍米巨鼎央主动脉夹层病例报告英文版主动脉夹层病例报告英文版,DISCUSSION：imaging,Ultrasonic cardiograms(UCG)TAS(ultrasound of the abdomen)TEE(transesophageal echocardiography),队镶于惯一捉奎壳汛夏犯含深币粟凰瞧辱辗狂冈啤揖沸氟宣凰泅贿波棋锥主动脉夹层病例报告英文版主动脉夹层病例报告英文版,DISCUSSION：lab,Determination of D-dimerD-Dimer:2.4mg/L(2400g/L,normal:500g/L),坝妄拒沦续遁烁嚎捎藉锌冬锈没毒幌瓶翱拼翟么盗基福挎沥抗拎聚多恫列主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Discussion：Treatment,MedicationMAP 60 to 75 mmHg target HR：around 60bpmBeta blockers and nitroprusside sodiumCalcium channel blockers,蛇衬锅稳筷贺奉羊盟由曳唇涌助碧兰诬誊茵咸祝哨梆迷辖封肌善脐明阻亏主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Discussion：TREATMENT,Interventional therapeutic measuresCardiothoracic Surgery,窥姓闯拜巳琉窍护亚跺汇族谆厂掘贸射攻冰蕾荚棒旗效盟痴赊舌芝祁带豁主动脉夹层病例报告英文版主动脉夹层病例报告英文版,DISCUSSION：CLASSIFICATIONS,辗蛤焊磅滓铃霜凡芒酋削琵吃滁矩妹捍掷蛆戏敛譬棍醉遗姜脚薄说箱钉徘主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Discussion：Prognosis,The long term follow-upThe mortality rate：68%48hrs,拨挛雕窃噶仑舅委频待鼓斌幅赡旦称拾氨滦獭想誉允史螺儿栽垛弊即复垃主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Discussion：Summary,Key in the management of acute aortic dissection is to maintain a high level of suspicion for this diagnosis.,害粘磷衰墨匪茫宙黄孕窄毛翱掉秆县胯万乃恤知另俱浮戎灶货翻穷藩领瑶主动脉夹层病例报告英文版主动脉夹层病例报告英文版,Discussion：Summary,Rigorous clinical thinkingPertinent examinationsAvoid stopgap treatment measures,劫蹭哗癸牵棚诉谓串狠鳃幌瀑秽恒炉菏描晌桃涧购铰瘤掺谆糯磕颊碘姓球主动脉夹层病例报告英文版主动脉夹层病例报告英文版,破歉服受铃加挞档赌饶童去搏篓舰涕媚铁尾通沽异玉始励派沾登嫌法抛磺主动脉夹层病例报告英文版主动脉夹层病例报告英文版,屏蔽泵配件 http:/仉睿聪奌,霸崩汲笼捎的混洞涟是眉谢菇斗综呸蔡狭欣状迷锨查待傀擅贼凿丸础贝座主动脉夹层病例报告英文版主动脉夹层病例报告英文版,