Ruptured Ovarian Artery Pseudoaneurysm in a Postmenopausal Patient Treated with Transcatheter Embolization

Abstract

卵巢动脉伪肿瘤是相对罕见的实体，通常与妊娠或早期的后期期间相关。年龄较大的女性发生甚至不那么常见。我们在老年后绝经患者中提出了一种破裂的卵巢动脉伪肿瘤，用经截面栓塞成功处理。

1.介绍

卵巢动脉伪肿瘤的破裂包括在自发的Atraumatic腹膜后出血的差异诊断中。它们是相对罕见的实体，大多数人在怀孕晚期或早期的后期发生。绝经后患者的这种发生甚至不那么常见，在世界文学中报告的少于10例。

血管造影与栓塞已更换开放式手术作为治疗这种病变的选择。

We present an additional case of spontaneous rupture of an ovarian artery pseudoaneurysm in a postmenopausal patient.

2.案例介绍

A 59-yeart-old black female presented to the emergency department with acute onset of abdominal pain, hypotension, and severe anemia. There is a history of chronic lymphocytic leukemia, currently in remission as well as medically controlled hypertension. In the emergency room, laboratory values were remarkable for , , , , , ,和 .The patient was immediately transfused 3 units packed RBCs, 2 liters crystalloid, and appropriate calcium infusion. A contrast-enhanced CT scan of the abdomen and pelvis was performed which demonstrated active extravasation of contrast in the right infrarenal retroperitoneal space (Figure1(a)）。CTA重建表明来自右卵巢动脉的起源（图1(b)）。

(a)

(b)

(a)
(b)

Figure 1

(a) Axial image from contrast-enhanced CT demonstrates collection of contrast suggestive of pseudoaneurysm (arrow) with surrounding massive retroperitoneal hemorrhage. (b) Coronal maximum intensity projection image from CT scan shows partial filling of vessel arising from the aorta presumed to be the right ovarian artery (open arrow) and collection of contrast suggestive of pseudoaneurysm (solid arrow).

将患者直接脱介到介入放射学，其中腹部主动脉图显示出右上象限的对比外渗。选择性右肾脏和右上腰椎注射率没有异常。正确的卵巢动脉插管，注射液显示出近端右卵巢动脉的伪肿瘤，其相关的活跃的对比度（图2）。A 3 fr coaxial Progreat catheter (Terumo) was advanced through the 5 fr angiographic catheter, and the vessel was embolized to the point of occlusion with multiple metallic microcoils measuring 3 to 5 mm diameter (Figure3）。

Figure 2

Right ovarian arteriogram demonstrating proximal pseudoaneurysm (arrow) and adjacent active extravasation (arrowhead).

Figure 3

Postembolization image demonstrates multiple metallic coils and cessation of flow within the right ovarian artery.

The patient received an additional transfusion of 3 units packed RBCs the following day. The patient’s clinical course stabilized, and she was discharged seven days after admission. The final hemoglobin/hematocrit rose to 8.7/24.9, the WBC count decreased to 17.5, and BUN/creatinine decreased to 13/1.4. The remote history of chronic lymphocytic leukemia was not considered a factor in the events of the current admission.

3.讨论

Ovarian artery aneurysms are relatively rare lesions, and the majority are related to pregnancy, either late in its course or in the early postpregnancy period [1-4]. Several factors have been implicated, including hemodynamic changes such as increased blood volume and cardiac output as well as hormonal changes predisposing to aneurysm formation [1–4]。We have been able to find only seven reported cases of ovarian artery pseudoaneurysms in postmenopausal patients [2–8]。剖宫产后的前两年，举行了两种额外的病例[489,10]。

遥远过去的外科干预有一种指示，但近期历史上的所有报告的病例都已经成功地与经截面栓塞进行了成功管理。我们存在的情况是额外的罕见腹膜出血，与卵巢动脉伪肿瘤中的卵巢动脉伪随因子栓塞成功管理的卵巢动脉伪肿瘤的特征破裂有关。

Consent

The patient is sufficiently anonymized.

利益冲突

作者声明他们没有利益冲突。

参考资料

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