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首页> 外文期刊>The Internet Journal of Anesthesiology >An Unusual Presentation of Aorto-caval Fistula
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An Unusual Presentation of Aorto-caval Fistula

机译：主动脉腔瘘的异常表现

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We report a case of a 77 year-old male who presented with symptoms and signs consistent with congestive cardiac failure and concomitant acute lower respiratory tract infection. He failed to respond to conventional medical management and became anuric prompting further investigation. Radiological imaging confirmed an infra-renal abdominal aortic aneurysm (AAA). Prior to surgery delayed onset of anaesthesia was noted at induction and the patient required large doses of inducing agents and muscle relaxants to achieve adequate anaesthesia. This was thought to indicate the presence of an aorto-caval fistula (ACF). Indeed at operation an inflammatory AAA with a concomitant ACF was noted. We suggest that the delayed onset of anaesthesia during induction may indicate the presence of an ACF in patients with an AAA. Case History A 77-year-old male presented with a 3 day history of a productive cough and fever. He had no significant past medical history and had had no previous surgery. He had a weight of 70 kg. Examination revealed a temperature 37.1°C, pulse 110/min regular, respiratory rate 20/min, blood pressure 90/50mmHg and SpO2 92% on air. The patient had dry mucosal membranes and reduced skin turgor. Cardio-respiratory examination revealed bibasal inspiratory crepitations more prominent at the right base and bilateral pitting pedal oedema. Abdominal examination revealed no abnormalities. All peripheral pulses were present and were normal in character. There was no lower limb venous congestion noted. Haematological investigations showed a WCC 19.5x109/l. Blood biochemistry was within normal parameters but C-Reactive Protein (CRP) was raised at 223mg/l. Urinalysis revealed no abnormality. Electrocardiogram (ECG) showed no acute changes. Plain chest radiography revealed bilateral basal pulmonary shadowing more prominent the right lung base. A provisional diagnosis of congestive cardiac failure with concomitant right basal pneumonia was made. The patient was commenced upon diuretics and intravenous antibiotics. Subsequent sputum cultures were negative. 24 hours after admission the patient became anuric and renal function deteriorated (urea 17.2mM/l and creatinine 177uM/l). Emergent abdominal ultrasound revealed an 8 cm abdominal aortic aneurysm (AAA). Haemodynamically the patient had remained stable (pulse 109/min, BP 139/79 and SpO2 96% on air) and so a non-contrast CT scan of the abdomen was performed. This confirmed an 11 cm infra-renal AAA with intra-peritoneal fluid suggesting that it had ruptured (Figure 1). The patient was consented and prepared for emergency laparotomy.
机译：我们报告了一例77岁男性，其症状和体征与充血性心力衰竭和伴随的急性下呼吸道感染一致。他没有对常规的医疗方法做出反应，并变为无尿，促使进一步调查。影像学检查证实了肾下腹主动脉瘤（AAA）。在手术之前，在诱导时注意到麻醉的延迟发作，并且患者需要大剂量的诱导剂和肌肉松弛剂以实现充分的麻醉。人们认为这表明存在主动脉瘘（ACF）。确实在手术中发现了发炎的AAA伴有ACF。我们建议诱导期间麻醉的延迟发作可能表明AAA患者存在ACF。病史一名77岁的男性因咳嗽和发烧三天而有病史。他没有重要的既往病史，也没有做过手术。他的体重为70公斤。检查显示温度为37.1°C，规律脉搏110 / min，呼吸频率20 / min，血压90 / 50mmHg，SpO2在空气中为92％。该患者粘膜干燥，皮肤膨大。心脏呼吸检查显示，右基部和双侧pedal陷性水肿在双基础吸气性prominent裂更为明显。腹部检查未发现异常。存在所有外围脉冲，并且特征正常。没有发现下肢静脉充血。血液学检查显示WCC为19.5x109 / l。血液生化处于正常参数范围内，但C反应蛋白（CRP）升高至223mg / l。尿液分析未发现异常。心电图（ECG）未显示急性变化。胸部X线平片显示双侧基础肺阴影较右肺底突出。初步诊断为充血性心力衰竭并伴有右基础性肺炎。患者开始使用利尿剂和静脉注射抗生素。随后的痰培养阴性。入院后24小时，患者无尿，肾功能恶化（尿素17.2mM / l和肌酐177uM / l）。腹部新兴超声显示腹部主动脉瘤（AAA）为8厘米。血液动力学上患者保持稳定（在空气中脉冲109 / min，血压139/79和SpO2 96％），因此对腹部进行了非对比CT扫描。这证实了11厘米的肾下AAA腹膜内积液，表明它已经破裂（图1）。患者已被同意并准备进行紧急剖腹手术。

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