布鲁菌感染性腹主动脉假性动脉瘤误诊一例分析  

Misdiagnosis of A Patient with Brucella Infection-induced Abdominal Aortic Pseudoaneurysm

作　　者：张勇 梁家立 任超 王惠 ZHANG Yong;LIANG Jiali;REN Chao;WANG Hui(Department of Cardiosurgery,the 960th Hospital of the PLA,Ji'nan,Shandong 250031,China;Department of Ultrasound Diagnosis,the 960th Hospital of the PLA,Ji'nan,Shandong 250031,China)

机构地区：[1]解放军第九六〇医院心脏外科,济南250031 [2]解放军第九六〇医院超声诊断科,济南250031

出　　处：《临床误诊误治》2025年第5期1-5,共5页Clinical Misdiagnosis & Mistherapy

基　　金：济南市医学科技创新计划(202134002)。

摘　　要：目的分析布鲁菌感染性腹主动脉假性动脉瘤的误诊原因及治疗方法。方法回顾分析2021年就诊的1例布鲁菌感染性腹主动脉假性动脉瘤误诊患者的诊疗过程。结果本例男35岁,因腹痛1 d、加重1 h就诊,初步检查后考虑腹主动脉假性动脉瘤,行腹主动脉腔内隔绝术,术后3个月于支架远端再次出现腹主动脉假性动脉瘤,后经追问生活居住史及行虎红平板凝集试验(RBPT)、试管凝集试验(SAT)、主动脉CT血管造影检查确诊为布鲁菌感染性腹主动脉假性动脉瘤,并予腹主动脉人工血管置换术,术后接受规范的抗菌药物治疗。误诊时间3个月。术后随访1年,患者整体状况良好,腹痛症状消失,CT血管造影显示腹主动脉人工血管通畅。结论目前布鲁菌感染性腹主动脉假性动脉瘤发病率虽不高,但部分患者瘤体破裂风险较大,详细询问患者生活居住史,熟悉临床表现及主动脉CT血管造影影像学特点,及早行针对性实验室检查(RBPT、SAT)及主动脉CT血管造影检查多可明确诊断。规范的抗菌药物联合手术治疗是本病安全有效的治疗方法。Objective To analyze the causes of misdiagnosis and treatment of brucella infection-induced abdominal aortic pseudoaneurysm(AAP).Methods The diagnosis and treatment process of a misdiagnosed patient with brucella infection-induced AAP in 2021 was retrospectively analyzed.Results A 35-year-old male patient presented with abdominal pain for 1 d which was aggravated for 1 h.After preliminary examination,AAP was considered and endoaortic isolation was performed.AAP appeared again at the distal end of the stent at 3 months after surgery.After follow-up,brucella infection-induced AAP was confirmed by inquiry about living and residence history,rose bengal plate agglutination test(RBPT),standard tube agglutination test(SAT)and aortic CT angiography.The abdominal aorta underwent artificial vascular replacement and received standard antibiotic therapy after surgery.Misdiagnosis lasted 3 months.At 1-year follow-up,the overall condition of the patient was good,the symptoms of abdominal pain disappeared,and CT angiography showed that the artificial blood vessels of the abdominal aorta were smooth.Conclusion Although the incidence of misdiagnosis of brucella-induced AAP is not high currently,some patients have a greater risk of tumor rupture.Detailed inquiry into the life and residence history of patients,being familiar with the clinical manifestations and imaging characteristics of aortic CTA,and early targeted laboratory examination(RBPT,SAT)and aortic CTA can help make a definite diagnosis.Standard antibiotics combined with surgical treatment is a safe and effective treatment for this disease.

关 键 词：布鲁菌 腹主动脉瘤 误诊 动脉瘤 感染性 人工血管置换 虎红平板凝集试验 试管凝集试验 CT血管造影 

分 类 号：R654.3[医药卫生—外科学]