胸主动脉瘤课件_4.pptVIP

Pathology and classification According to the layers involved; True aneurysm(真性动脉瘤): all-layer dilation; Pseudoaneurysm (false aneurysm 假性动脉瘤): no layer of arterial wall or only adventitia; Dissecting aortic aneurysm (主动脉夹层动脉瘤): middle layer dissection. Pathology and classification According to the shape of TAA: Saccular aneurysm （囊状动脉瘤）: local lateral aortic wall protrusion; Fusiform aneurysm （梭状动脉瘤）: spindle-like; compression and rupture; Dissecting aneurysm （夹层动脉瘤）: ——Classification Pathology and classification According to the location of TAA Ascending aorta aneurysm; Aortic arch aneurysm; Descending aorta aneurysm; Thoracoabdominal aneurysm (胸腹主动脉瘤): TAA involves the abdominal aorta Pathology and classification(aortic dissection) Clinical presentation(true aneurysm) Aortic valve incompetence: aortic regurgitation Compression: Chest pain; superior vena cava obstruction - ascending aorta TAA Dyspnea; cough – aortic arch TAA Hoarseness; Horner’s syndrome; dysphagia; dyspnea -descending aorta TAA Rupture : acute pain; shock; hemothorax; pericardial tamponade --- death; Diagnosis Asymptomatic: chest x-ray Symptomatic: pain ; compression; Physical examination: indirect signs; Imaging: determinating CT MRI aortography Diagnosis: aortography Diagnosis: Differential Diagnosis Dissecting TAA— Angina pectoris; Acute myocardial infarction; Pulmonary embolism; Acute abdomen; …… T r e a t m e n t Conservative therapy: Indication: 1. Poor general condition; 2. Aortic diameter 4cm; 3. Type III aortic dissection without severe ischemia and danger of rupture. Therapy: