2024年 · 第39卷第01期

A 66-year-old male was admitted to the Department of Respiratory Medicine due to sudden shortness of breath for 6 h. Physical examination: No obvious abnormalities were found in auscultation of both lungs and heart. The abdomen was flat and soft, a pulsatile mass was palpable in the right lower abdomen, the bilateral femoral artery pulsation was palpable, and the right lower limb was moderately edema. The past history of hypertension is more than 20 years, and the history of coronary heart disease is more than 2 years. Cardiac color ultrasound: pulmonary hypertension; Electrocardiogram and related myocardial enzymes indicated: coronary heart disease, acute coronary syndrome; Lower extremity venous ultrasound: Right femoral vein flow rate decreased; B-type natriuretic peptide (BNP): 496 pg/ml. Diagnosis: (1) coronary heart disease, acute coronary syndrome, heart failure; (2) Hypertension. After vascular surgery consultation, CT angiography (CTA) of the abdominal aorta showed that multiple transmural ulcers and aneurysms were formed, and the proximal transmural ulcer of the right common iliac artery combined with aneurysm formation was considered to form an arteriovenous fistula with the right common iliac vein, and aneurysms at the origin of the left common iliac artery and left internal partial artery. Supplementary diagnosis: abdominal main and bilateral iliac artery aneurysm, right iliac artery-right iliac vein arteriovenous fistula. The patient's cardiopulmonary and other medical conditions were corrected and improved and then transferred to the vascular surgery department for surgical treatment. The patient was taken into the recumbent position, and through bilateral femoral artery approach, ultra-smooth guide wire and labeled catheter were placed into the upper abdominal aorta for angiography: aneurysm-like imaging of the lower abdominal aorta and right iliac artery, and iliac vein and inferior vena cava imaging (Figure 1). Medtronic abdominal aorta main body stent system 25-13-120 mm was selected, and the main body stent was placed in the abdominal aorta through extra-rigid guide wire. After accurate positioning, the main body stent was slowly released to be anchored at the level of the lower edge of the renal artery opening. The main body stent was released to the left common iliac artery. Angiography showed that the main body stent position was well positioned. The C2 catheter was matched with super-slippery guide wire through the right common femoral artery approach, and the short branch of the main body of the right stent was superselected. The extra-rigid guide wire was replaced and a 16-10-120 mm split stent was placed through the right common femoral artery to cover the right common iliac and internal iliac arteries. The angiography showed smooth blood flow in the stent, no obvious internal fistula, and no iliac vein and inferior vena cava imaging (Figure 2). 4-year follow-up: No signs of pulmonary hypertension were found in color Doppler ultrasound; BNP: 72 pg/ml; CTA of the abdominal aorta showed that the stent was in good position and shape, without obvious endoleak, and no advance development of the right common iliac vein and inferior vena cava (Figure 3).

A 6-year-old male complained of persistent fever accompanied by neck pain and swelling 3 days ago. Physical examination: the skin of the neck is slightly red, the skin temperature is increased, the thyroid gland is swollen II °, and the tenderness is obvious. Color ultrasound examination: A hypoechoic mass was detected in the left lobe of the thyroid gland, with a range of about 3.0 cm ×1.9 cm ×2.5 cm. A long strip of strong echo was seen in the hypoechoic gland, with a size of 1.7 cm ×0.1 cm ×0.1 cm. It suggests that thyroid foreign body with peripheral inflammation may be. Routine blood test: white blood cells 8.7×10⁹/L, neutrophil percentage 84.9%, neutrophil absolute value 7.3×10⁹/L. Serum CRP was 48.9 mg/L, thyroglobulin was 197 ng/ml, TSH, FT3 and FT4 were normal. CT examination of the neck showed that the lymph nodes of the neck were enlarged, inflammatory lesions in the left lobe of the thyroid gland, and no foreign body was found in the thyroid region. Intraoperative exploration showed that the left lobe of the thyroid gland was obviously enlarged, the gland was brittle, edema, and adhered to the surrounding tissues. The left glandular lobe was free and the foreign body was not palpable. The 5 ml syringe needle was bent to nearly 90° and pierced into the gland under real-time guidance of ultrasound until the needle tip reached the foreign body (Figure 1). Then, the thyroid gland is dissected perpendicular to the direction of the needle, and a little pus is seen. Suck the pus and continue to cut to needle level. At this time, a foreign object was found at the needle tip (Figure 2). The foreign body was a yellow soft object, approximately 1.7 cm long, which was anastomotic to the preoperative ultrasound examination (Figure 3). Another ultrasound examination was performed to confirm that there was no foreign body residue. The diseased tissue surrounding the foreign body was curetted with a curette. After repeated rinsing, continue to explore and see no obvious damage to esophagus and trachea. The thyroid section was sutured, and a drainage tube was placed in the surgical area. Postoperative medical history: His mother said that the child had eaten green wheat before the onset of the disease, and had pharyngeal discomfort during eating, and the symptoms disappeared after swallowing steamed buns. Combined with the characteristics and medical history of foreign bodies, it is considered that maimang punctures the esophagus and enters the thyroid gland to lead to foreign body formation. Pus cultures: Eikennia erodans. Pathological examination: (Thyroid) was submitted for hyperplasia of granulation tissue, vasodilatation and congestion with hemorrhage, acute and chronic inflammatory cell infiltration, and local necrosis.