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[Blue Journal临床医学影像]:EBUS发现的异常右侧锁骨下动脉
2017年09月26日 临床影像, 临床话题 暂无评论

Aberrant Right Subclavian Artery on EBUS

Nicholas M. Mark, David K. Madtes

Am J Respir Crit Care Med 2017

Published on 06-July-2017 as 10.1164/rccm.201704-0706IM

A 70 year old man underwent bronchoscopy under general anesthesia for biopsy of mediastinal adenopathy due to suspected lymphoma. The airways appeared normal, however on endobronchial ultrasound (EBUS) examination, a thick walled pulsatile mass posterior to the trachea was visualized (A). Doppler ultrasound (B) revealed pulsatile blood flow. Review of corresponding CT scan demonstrated an aberrant right subclavian artery (ARSA) passing behind the esophagus (arrow in C,D). Lymph node biopsy was completed safely. ARSA, or arteria lusoria is a rare anatomic variant, seen in 0.4-1.8% of the population[1] wherein the subclavian arises off the aorta instead of the brachiocephalic artery.[2] Occasionally ARSA can present with dysphagia (called dysphagia lusoria) from compression of the esophagus. ARSA and resulting esophageal compression was described as 'dysphagia lusus naturae' (Latin: ‘dysphagia freak of nature’) by English surgeon David Bayford in 1787.[3] Typically ARSA courses posterior to the esophagus (as shown), however in 5% of cases the ARSA runs anterior to the trachea. ARSA has been diagnosed using endoscopic ultrasound (EUS)[4], but to our knowledge this is the first English language report of EBUS used to identify ARSA.[5] Bronchoscopists should be aware of this finding, which illustrates the importance of Doppler ultrasound to identify vascular structures on EBUS.

一名70岁男性患者因怀疑淋巴瘤,在全麻下接受支气管镜检查行纵隔淋巴结活检。气道显示正常,然而,支气管内超声(EBUS)检查发现,主气管后方可见一个厚壁且有搏动感的肿块(A)。超声多普勒(B)显示为搏动性血流。复习相应的CT扫描发现,异常的右侧锁骨下动脉(ARSA)在食道后穿过(C、D中箭头所示)。淋巴结活检完成的十分顺利。ARSA是一种罕见的解剖变异,见于0.4-1.8%的人口,此时锁骨下动脉发出于主动脉而非头臂动脉。有时,ARSA压迫食管可表现为吞咽困难。1787年,英国外科医生David Bayfor将ARSA及其对食管造成的压迫描述为“吞咽障碍的先天畸形”。典型情况下,ARSA在食道后方穿过(如图所示),然而,约5%的病例的ARSA在气管前方通过。采用超声内镜(EUS)可诊断ARSA,但是,据我们所知,这是首次用英文报告采用EBUS诊断ARSA。进行支气管镜检查的医生应当了解这一情况,这也表明了在EBUS下多普勒超声对于鉴别血管机构的重要性。

 

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