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患者,男,64岁。因右上腹痛二年再发一周入院。体检:右上腹压痛明显,余无特殊。彩超检查:胆囊肿大,为7.5cm×2.2cm,内有多枚强回声光团伴声影,胆总管内径0.6cm。腹膜后腹主动脉前方、脾静脉后上方见3.9cm×3.6cm无回声区,边界清晰,壁较厚,内壁处见不规则强回声后方伴声衰减(图1)。CDFI:该无回声区内见彩色血流呈“漩涡样”,频谱呈动脉型、湍流,峰速为32cm/s(图2),可见彩色血流出入该无回声区(图3)。超声诊断:①胆囊肿大、胆囊结石;②腹腔动脉瘤可能。血管造影:肝总动脉起始部扩张呈球形,大小3.5cm×3.5cm,腔内边缘不规则,粥样斑块形成。
Patient, male, 64 years old. Due to the right upper quadrant pain, she was admitted to the hospital for another two weeks. Physical examination: The tenderness of the right upper quadrant is obvious, and the rest is not special. Color Doppler ultrasound examination: gallbladder enlargement, 7.5cm × 2.2cm, there are more than one strong echo group with acoustic shadow, common bile duct diameter 0.6cm. In the anterior part of the retroperitoneal abdominal aorta, a 3.9cm x 3.6cm echo-free zone was seen at the top of the splenic vein. The boundary was clear, the wall was thick, and the acoustic attenuation occurred behind the irregular strong echo on the inner wall (Figure 1). CDFI: The colorless blood flow in this echo-free area was “whirlpool-like” with an arterial pattern and turbulent flow. The peak velocity was 32 cm/s (Figure 2), and color blood flowed into the echo-free area (Figure 3). Ultrasound diagnosis: 1 gallbladder enlargement, gallbladder stones; 2 celiac aneurysms may be. Angiography: The beginning of the common hepatic artery expands to a spherical shape with a size of 3.5 cm x 3.5 cm, with irregular rims and atheromatous plaque formation.