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患者男,43岁。突发发热、左侧胁腹痛,进行性加重,既往无类似症状,无腹部创伤、结缔组织病、血管炎、感染和炎症。高血压病史4年,最高时约170/120 mmHg(1 mmHg=0.133 kPa),平日服用降压药。体检:体温38.5℃,血压150/95mmHg,腹平软,无压痛、反跳痛,左脊肋角叩击痛。实验室检查:无特殊。其父3年前死于高血压脑出血。肾动脉CTA:左肾动脉开口位置略低于右肾动脉,左肾动脉中远段增粗,内见长约2.1 cm低密度线样影,将肾动脉分为真、假两腔,夹层延伸至左肾动脉前支起始处,前支腔内充满软组织密度充盈缺损,左肾中下部肾组织低灌注。选择性肾动脉造影显示左肾动脉夹层和部分肾梗死。
Male patient, 43 years old. Sudden fever, left flank pain, progressive increase, no previous symptoms, no abdominal trauma, connective tissue disease, vasculitis, infection and inflammation. Hypertensive history of 4 years, the highest about 170/120 mmHg (1 mmHg = 0.133 kPa), taking antihypertensive drugs on weekdays. Physical examination: body temperature 38.5 ℃, blood pressure 150 / 95mmHg, abdominal soft, no tenderness, rebound tenderness, percussion pain pain left corner ribs. Laboratory tests: no special. His father died of hypertensive intracerebral hemorrhage three years ago. Left renal artery CTA: the position of the left renal artery slightly lower than the right renal artery, the middle and distal left renal artery thickening, see the length of about 2.1 cm low-density line-like shadow, the renal artery is divided into true and false two cavity, the dissection extends to the left The anterior branch of renal artery at the beginning of the anterior branch filled with soft tissue density filling defect, left renal lower kidney perfusion. Selective renal artery angiography showed left renal artery dissection and partial renal infarction.