2024年 · 第62卷第08期

The patient, a 45-year-old male, was seen in the Department of Immunology of our hospital on January 5, 2024 due to "Behcet's syndrome complicated with pseudoaneurysm for more than 2 years, abdominal pain, and recurrence of abdominal aortic pseudoaneurysm for more than 1 month". Two years ago, the patient underwent right carotid pseudoaneurysm embolization and stent implantation in an external hospital due to right carotid pseudoaneurysm, which was considered as Behcet's syndrome by the local hospital. One and a half years ago, due to a pseudoaneurysm above the bifurcation of the abdominal aorta, an integrated covered stent was implanted in an external hospital. Postoperatively, prednisone acetate (45 mg/d) + cyclophosphamide (the specific dose is unknown) was administered orally, and the dose of prednisone acetate was reduced to 5 mg/d. However, the patient did not take medication regularly. During this period, he voluntarily stopped taking glucocorticoids many times. One year after the operation, an abdominal aortic pseudoaneurysm near the kidney of the proximal end of the stent appeared again. The second time in an external hospital, he underwent naked abdominal aortic stent implantation + intratumoral spring bolt embolization, and oral prednisone acetate (35 mg/d) was added. One month ago, the patient felt dull abdominal pain, which progressively aggravated. CT findings in other hospitals showed that the diameter of the pseudoaneurysm at the proximal end of the abdominal aortic stent was significantly larger than before. The erythrocyte sedimentation rate was 6 mm/1 h, and the high-sensitivity C-reactive protein was 25.80 mg/L. For further treatment, he went to the Department of Immunology of our hospital. According to the repeated oral ulcers and multiple pseudoaneurysms, the patient was diagnosed as Behcet's syndrome with abdominal aortic pseudoaneurysm. Considering the poor control of Behcet's syndrome, it is recommended to increase glucocorticoids to 60 mg/d, concomitantly with oral cyclophosphamide 50 mg/d and immediate subcutaneous injection of adalimumab 40 mg once. Considering the large pseudoaneurysm and the high risk of rupture, after 2 weeks of drug treatment, I was transferred to our department on January 20th for continued treatment. The patient had repeated oral ulcers with fever for more than 5 years and hypertension for 2 years. One year ago, right popliteal artery thrombosis was found on examination, which improved after drug treatment. Physical examination: Body temperature 36.5 ℃, heart rate 84 beats/min, 18 breaths/min, blood pressure 122/91 mmHg (1 mmHg =0.133 kPa). A pulsatile mass with a maximum diameter of about 10 cm can be palpable under the xiphoid process with mild tenderness. Preoperative CT angiography showed a giant pseudoaneurysm of the abdominal aorta below the bilateral renal arteries. The maximum diameter of the tumor was 10.8 cm, and there was no anchoring area under the kidney. The previously implanted bare metal stent completely covered the superior mesenteric artery (SMA) and bilateral renal arteries. The branch vessels of the visceral region and the bilateral internal iliac arteries were patent (Figure 1).

The patient, a 65-year-old male, came to our hospital on 21 November 2023 due to "intermittent upper abdominal pain for 2 weeks". The patient developed upper abdominal pain without obvious trigger 2 weeks ago, showing intermittent distension and pain, with a digital pain score of 4~5 points, which could be relieved by itself after rest, without nausea and vomiting, chest tightness and shortness of breath, chills and high fever, and skin and sclera yellowing. One week ago, the patient's pain progressively worsened, with a digital pain score of 7 to 8 points, which could not be relieved by itself after rest, and his exhaust and defecation were normal. The patient lost 5 kg in 3 months. In the past, he had emphysema for 10 years and hypertension for 10 years. He denied the history of chronic diseases such as diabetes, coronary heart disease, mental illness and cerebrovascular disease. Deny history of surgery, trauma, blood transfusion and infectious disease. The patient had no history of alcohol consumption and smoked for about 40 years, with an average of 5 cigarettes/d. Physical examination: body temperature 36.0 ℃, heart rate 80 beats/min, respiratory rate 20 beats/min, blood pressure 130/90 mmHg (1 mmHg =0.133 kPa), height 170 cm, weight 55 kg, body mass index 19.03 kg/m², well-nourished. The elasticity of the skin was average, and the skin and sclera of the whole body were not yellowed, and there were no ecchymosis and pigmentation. The superficial lymph nodes were unpalpable and obviously enlarged, without tenderness, normal abdominal appearance, without abdominal wall varices, soft abdomen, positive upper abdominal tenderness, no rebound pain, unpalpable abdominal mass, unpalpable subcostal and xiphoid process of liver and spleen, Murphy sign (-).

The patient, a 66-year-old male, went to our hospital on September 21, 2022 due to "physical examination found that the upper pole of the left kidney occupied space". CT angiography of renal tumors showed mass occupation, and clear cell carcinoma was possible, with a size of 2.8 cm ×2.7 cm ×2.5 cm (Figure 1). The results of PET-CT examination showed mass occupation at the upper pole of the left kidney. Combined with enhanced scanning, malignant lesions were considered, and no other neoplastic lesions were found. Has a past history of hypertension, chronic obstructive pulmonary disease and cervical degeneration. Before 2013, he underwent "radical resection of right upper lung lung cancer" due to "lung cancer". In 2015, he underwent "percutaneous vertebroplasty" due to compression fracture of upper thoracic vertebra due to bone metastasis of lung cancer (Figure 2A), smoking history, 600 cigarettes/year, and has quit smoking for 9 years.