大動脈解離の定義 - j-ca.org

1 Online publication June 5, 2008. 2006 .. throm- bosed type .. intramural hematoma: IMH .. J Jpn Coll Angiol, 2008, 48: 7 11 . Key words: aortic dissection, dissecting aneurysm of the aorta, thrombosed subtype aortic dissection, intramural hematoma, ulcer-like projection .. initial tear primary tear .. entry .. aortic dissection .. re-entry .. entry .. 4 .. 1, 2 . 1cm .. re-dissection .. 3 .. re-canalization .. 4 . 1 2cm .. true lumen .. false lumen .. flap .. Fig. 1 1 tear .. 2 . communicating aortic dissection . dissecting aneurysm of the aorta . non-communicating aortic . dissection2 thrombosed type . 2007 11 22 . THE JOURNAL of JAPANESE COLLEGE of ANGIOLOGY Vol. 48, 2008 7.. intramural hematoma IMH .. tear . i n t r a m u r a l hematoma intramural hemorrhage: IMH .. Figure 1 Aortic dissection.. 5 8 . 9 variant aneurysm without intimal rupture . 1, 2 tear vasa vasorum .. 2 .. classic aortic dissection CT .. Fig. 2 . 13 CT .. tear .. 10.

2 16 .. tear .. Stanson IMH . penetrating .. atherosclerotic ulcers .. 11 . Fig. 3 u l c e r - l i k e 1920 Krukenberg projection .. 17 .. 1 1931 .. Tyson12 1952 Gore13 . CT .. MR .. hematoma . thrombus .. 11, 14, 15 . CT .. Fig. 4 .. Tyson .. dissecting hematoma of the aorta .. intramural hematoma .. hematoma .. + .. dissecting . 8 Vol. 48, 2008.. Figure 2 Variation of aortic dissection. Thrombus Figure 3 Classification of aortic dissection.. 1966 Dinsmore19 .. local opacification .. hematoma X . ulcer . ULP .. CT MR . 20, 21 . Ulcer-like projection tear .. ulcer-like projection: ULP = . 18 . 1965 Eyler . penetrat- clotted false channel ing aortic ulcer . Vol. 48, 2008 9.. Figure 4 Hematoma, hemorrhage, thrombus. 17 . Penetrating atherosclerotic aortic ulcer .. Stanson .. PAU 17 . penetrating atherosclerotic ulcer . ULP penetration .. N ULP . 22 penetration .. 23 PAU .. CT .. DSA 70 80 PAU . CT 20 40 ULP ulcer-like . MDCT projection.

3 Intramural = intra-medial he- .. matoma .. 1 Nienaber CA, Eagle KA: Aortic dissection: new frontiers in . diagnosis and management: Part I: from etiology to diagnos- . tic strategies. Circulation, 2003, 108: 628 635. ULP 2 Erbel R, Alfonso F, Boileau C et al: Diagnosis and manage- ment of aortic dissection. Eur Heart J, 2001, 22: 1642 1681. 3 Hirst AE Jr, Johns VJ Jr, Kime SW Jr: Dissecting aneurysm of the aorta: a review of 505 cases. Medicine, 1958, 37: 10 Vol. 48, 2008.. 217 279. 1989 . 4 10 153 169 .. 2006 . Circulation J 15 Matsuo H: Recognition and management of thrombosed 2006 70 Suppl IV 1569 1677 type of aortic dissection with long-term follow-up results. 5 . Evangelista A, Dominguez R, Sebastia C et al: Long-term Int J Angiol, 2000, 9: 27 30. follow-up of aortic intramural hematoma: predictors of out- 16 . come. Circulation, 2003, 108: 583 589. 1 . 6 Nishigami K, Tsuchiya T, Shono H et al: Disappearance of 1996 85 118 120 . aortic intramural hematoma and its significance to the prog- 17 Stanson AW, Kazmier FJ, Hollier LH et al: Penetrating ath- nosis.

4 Circulation, 2000, 102 (19 Suppl 3): III243 III247. erosclerotic ulcers of the thoracic aorta: natural history and 7 von Kodolitsch Y, Cs sz SK, Koschyk DH et al: Intramural clinicopathologic correlations. Ann Vasc Surg , 1986, 1: 15 . hematoma of the aorta: predictors of progression to dissec- 23. tion and rupture. Circulation, 2003, 107: 1158 1163. 18 Eyler WR, Clark MD: Dissecting aneurysms of the aorta: 8 Evangelista A, Mukherjee D, Mehta RH et al: Acute intra- roentgen manifestations including a comparison with other mural hematoma of the aorta: a mystery in evolution. Circu- types of aneurysms. Radiology, 1965, 85: 1047 1057. lation, 2005, 111: 1063 1070. 19 Dinsmore RE, Rourke JA, DeSanctis RD et al: Angiographic 9 Shimizu H, Yoshino H, Udagawa H et al: Prognosis of aor- findings in dissecting aortic aneurysm. N Engl J Med, 1966, tic intramural hemorrhage compared with classic aortic dis- 275: 1152 1157. section. Am J Cardiol, 2000, 85: 792 795.

5 20 Heiberg E, Wolverson M, Sundaram M et al: CT findings 10 Vilacosta I, San Rom n JA, Ferreir s J et al: Natural history in thoracic aortic dissection. AJR Am J Roentgenol, 1981, and serial morphology of aortic intramural hematoma: a novel 136: 13 17. variant of aortic dissection. Am Heart J, 1997, 134: 495 21 Geisinger MA, Risius B, O'Donnell JA et al: Thoracic aortic 507. dissections: magnetic resonance imaging. Radiology, 1985, 11 Matsuo H: The thrombosed type of aortic dissection-its clini- 155: 407 412. cal features and diagnosis. Int J Angiol, 1998, 7: 329 334. 22 Ganaha F, Miller DC, Sugimoto K et al: Prognosis of aortic 12 Tyson MD: Dissecting aneurysms. Am J Path, 1931, 7: 581 intramural hematoma with and without penetrating athero- 603. sclerotic ulcer: a clinical and radiological analysis. Circula- 13 Gore I: Pathogenesis of dissecting aneurysm of the aorta. tion, 2002, 106: 342 348. AMA Arch Pathol, 1952, 53: 142 153. 23 Harris JA, Bis KG, Glover JL et al: Penetrating atheroscle- 14 rotic ulcers of the aorta.

6 J Vasc Surg, 1994, 19: 90 98. Definition of Aortic Dissection Hiroshi Matsuo Matsuo Cardiovascular Clinic, Osaka, Japan Key words: aortic dissection, dissecting aneurysm of the aorta, thrombosed subtype aortic dissection, intramural hematoma, ulcer-like projection Aortic dissection has two lumens which are true lumen, and false lumen in that the layer of dissection is the media. Dissecting aneurysm of the aorta means aneurysmal dilatation of the aorta in patients with aortic dissection. We examined the lesions to determine whether aortic dissection of the double barreled aorta (communicating aortic dissec- tion), in which the true lumen and the false lumen communicated, or the thrombosed subtype (non-communicating aortic dissection), in which the false lumen is filled with clot formation, also known as intramural hematoma. (J Jpn Coll Angiol, 2008, 48: 7 11). Online publication June 5, 2008. Vol. 48, 2008 11.