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NEJM:食管吞咽性困难-案例报道

2016-07-29 MedSci MedSci原创

患者男性,46岁,出现间歇性吞咽固体性食物困难病史1年余。

患者男性,46岁,出现间歇性吞咽固体性食物困难病史1年余。

 
常规体格检查未见异常。

吞钡检查结果显示食管后壁斜向凹陷(如图A箭头处,图B中“T”为食管)。

胸部CT增强扫描显示右锁骨下动脉(图B箭头处;图C为三维重建结构显示),双颈动脉干远端(图C,星号处)和左锁骨下动脉异常。

食管后的右锁骨下动脉异常病变导致食管显著被压缩,这与患者的症状表现是一致的。

由于目前患者吞咽困难只是轻度至中度,拒绝进行手术治疗,最后经血管外科医生会诊后,决定对其保守治疗和改变生活方式来减缓病变的加快。

在临床上,一般情况下患者锁骨下动脉出现病变,通常不表现出任何的症状。当小儿出现锁骨下动脉病变时,有可能会出现反复性地肺部感染或喘鸣,甚至也可能出现吞咽困难现象。

但是,类似于本案例中症状,在成年人中确是比较罕见的。 

原始出处:

Bartosz Hudzik, M.D., Ph.D.Mariusz Gąsior, M.D., Ph.D. Dysphagia Lusoria N Engl J Med 2016; 375:e4July 28, 2016

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    2016-09-25 1e10c84am36(暂无匿称)

    文章很好值得关注

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=135061, encodeId=863e13506185, content=文章很好值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 25 17:11:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134915, encodeId=62791349155f, content=文章很好值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 25 09:17:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95343, encodeId=99759534329, content=不错,提高了临床经验, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCX1ofdPI8aHWasK2VMACQTBoE3olgghXDUT3tmTldxbO7tXzSwZId20SSR6iaUMOdF6yZkwyWFSicQ/0, createdBy=2c121929208, createdName=龙家超包, createdTime=Sun Jul 31 22:10:00 CST 2016, time=2016-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95271, encodeId=6745952e194, content=好吧!确实出现吞咽困难不能只说是食管肿瘤, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b09f1636586, createdName=onetree, createdTime=Sun Jul 31 11:44:00 CST 2016, time=2016-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95204, encodeId=4e509520414, content=文章不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zGdN1x8J6HqtUI2Gpibk3sfIIBhZchAhjoiaCQlficdtQTnEqYncy3GVEMPIOJwD7t0mO2KfYGMgkIg/0, createdBy=86081727811, createdName=4546wk, createdTime=Sun Jul 31 10:47:00 CST 2016, time=2016-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1437128, encodeId=2fd4143e128eb, content=<a href='/topic/show?id=0e311010591a' target=_blank style='color:#2F92EE;'>#食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101059, encryptionId=0e311010591a, topicName=食管)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sun Jul 31 06:10:00 CST 2016, time=2016-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95166, encodeId=a61495166e9, content=学习个案,增加经验。, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Sat Jul 30 23:00:00 CST 2016, time=2016-07-30, status=1, ipAttribution=)]
    2016-09-25 1e10c84am36(暂无匿称)

    文章很好值得关注

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=135061, encodeId=863e13506185, content=文章很好值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 25 17:11:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134915, encodeId=62791349155f, content=文章很好值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 25 09:17:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95343, encodeId=99759534329, content=不错,提高了临床经验, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCX1ofdPI8aHWasK2VMACQTBoE3olgghXDUT3tmTldxbO7tXzSwZId20SSR6iaUMOdF6yZkwyWFSicQ/0, createdBy=2c121929208, createdName=龙家超包, createdTime=Sun Jul 31 22:10:00 CST 2016, time=2016-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95271, encodeId=6745952e194, content=好吧!确实出现吞咽困难不能只说是食管肿瘤, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b09f1636586, createdName=onetree, createdTime=Sun Jul 31 11:44:00 CST 2016, time=2016-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95204, encodeId=4e509520414, content=文章不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zGdN1x8J6HqtUI2Gpibk3sfIIBhZchAhjoiaCQlficdtQTnEqYncy3GVEMPIOJwD7t0mO2KfYGMgkIg/0, createdBy=86081727811, createdName=4546wk, createdTime=Sun Jul 31 10:47:00 CST 2016, time=2016-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1437128, encodeId=2fd4143e128eb, content=<a href='/topic/show?id=0e311010591a' target=_blank style='color:#2F92EE;'>#食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101059, encryptionId=0e311010591a, topicName=食管)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sun Jul 31 06:10:00 CST 2016, time=2016-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95166, encodeId=a61495166e9, content=学习个案,增加经验。, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Sat Jul 30 23:00:00 CST 2016, time=2016-07-30, status=1, ipAttribution=)]
    2016-07-31 龙家超包

    不错,提高了临床经验

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=135061, encodeId=863e13506185, content=文章很好值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 25 17:11:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134915, encodeId=62791349155f, content=文章很好值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 25 09:17:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95343, encodeId=99759534329, content=不错,提高了临床经验, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCX1ofdPI8aHWasK2VMACQTBoE3olgghXDUT3tmTldxbO7tXzSwZId20SSR6iaUMOdF6yZkwyWFSicQ/0, createdBy=2c121929208, createdName=龙家超包, createdTime=Sun Jul 31 22:10:00 CST 2016, time=2016-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95271, encodeId=6745952e194, content=好吧!确实出现吞咽困难不能只说是食管肿瘤, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b09f1636586, createdName=onetree, createdTime=Sun Jul 31 11:44:00 CST 2016, time=2016-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95204, encodeId=4e509520414, content=文章不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zGdN1x8J6HqtUI2Gpibk3sfIIBhZchAhjoiaCQlficdtQTnEqYncy3GVEMPIOJwD7t0mO2KfYGMgkIg/0, createdBy=86081727811, createdName=4546wk, createdTime=Sun Jul 31 10:47:00 CST 2016, time=2016-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1437128, encodeId=2fd4143e128eb, content=<a href='/topic/show?id=0e311010591a' target=_blank style='color:#2F92EE;'>#食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101059, encryptionId=0e311010591a, topicName=食管)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sun Jul 31 06:10:00 CST 2016, time=2016-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95166, encodeId=a61495166e9, content=学习个案,增加经验。, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Sat Jul 30 23:00:00 CST 2016, time=2016-07-30, status=1, ipAttribution=)]
    2016-07-31 onetree

    好吧!确实出现吞咽困难不能只说是食管肿瘤

    0

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    2016-07-31 4546wk

    文章不错

    0

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    2016-07-31 zhouqu_8
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    2016-07-30 刘煜

    学习个案,增加经验。

    0

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