病史与查体：
A 90-year-old man with a history of coronaryartery disease, hypertension, and a 30-pack-year smoking history presents to the outpatient clinic for his annual checkup. He denies recent complaints,although reports that he has not been as “active” lately. He has a history of good adherence to health maintenance recommendations, and results of recent colonoscopy and prostate examination are negative. He takes aspirin,metoprolol, and an occasional multivitamin. He admits to having problems with smoking cessation. Vital signs include a temperature of 37.0°C (98.6°F), bloodpressure of 120/80 mm Hg, pulse rate of 60/min, and respiratory rate of 10/min.Physical examination shows a thin, elderly man with mottled skin. His head,ears, eyes, nose, and throat (HEENT); neck; chest; and cardiac examinations areunremarkable. His abdomen is nontender and nondistended, but a pulsating massis palpated approximately 2 cm superior to his umbilicus, 1 cm left of midline.
一个有冠状动脉疾病、高血压病史和三十年吸烟史的九十岁男子到门诊诊所进行他的年度体检。他否认最近得过疾病，但是最近状态并不好。他曾经很好地坚持着健康的建议，但是最近的结肠镜检查和前列腺检查并不乐观。他服用阿司匹林、美托洛尔、偶尔服用复合维生素。他承认他在戒烟方面存在问题。生命体征：体温为37°C（98.6°F），血压为120 / 80毫米汞柱，脉搏率为60次 / min，呼吸速率为10 次/ min。体检显示老人消瘦，并且皮肤斑驳。他的头部，耳部，眼部，鼻子，咽喉；颈部；胸部和心脏检查未见明显异常。他的腹部无触痛和肿胀，但是在脐上2厘米中线左1厘米处可触诊到搏动肿块。
诊断与治疗：
1. What is the most likelydiagnosis?
A pulsatile abdominal mass suggests anabdominal aortic aneurysm (AAA). Approximately 30% of AAAs are discoveredduring routine physical examinations, although they are more difficult todetect in obese patients or when the aneurysm is small.
1. 最有可能的诊断是什么？
搏动性腹部肿块有可能是腹主动脉瘤（AAA）。虽然对于肥胖患者及动脉瘤较小时体检发现较为困难，但是大约30%的腹主动脉瘤由体检发现。
2. What is the epidemiology of this condition?
AAAs occur almost exclusively in people >60 years old (approximately 4–9% of people > 60 have an AAA) and account for approximately 15,000 deaths per year in the United States. An AAA is associated with advanced age, atherosclerosis, smoking, hypertension, and a family historyof AAA.
2. 这种疾病的流行病学是什么？
腹主动脉瘤主要发生在六十岁以上的人群中（大约有4%-9%的六十岁以上的人患有动脉瘤），在美国每年大约有15000人因动脉瘤死亡。腹主动脉瘤的发病与较高的年龄、动脉粥样硬化、吸烟、高血压、家族病史有关。
3. What is the natural history of this condition?
Most, if not all, AAAs tend to grow.Morbidity and mortality are related primarily to the risk of rupture, which isdirectly proportional to aneurysm size (risk is markedly increased in aneurysms> 5.5 cm in diameter), and may be independently related to the rate ofaneurysm growth. The risk of rupture is also increased by female gender,continued smoking, uncontrolled hypertension, and increased aortic wall stress.
3. 这种疾病的自然史是什么？
首先，并不是全部腹主动脉瘤都有生长倾向。发病率与死亡率首先与破裂风险有关，而破裂风险与动脉瘤的大小呈正相关（直径大于5.5cm的动脉瘤的破裂风险显著增加）并且与动脉瘤的生长速度独立相关。女性患者、持续性吸烟、不可控高血压、主动脉壁压力升高也可增加破裂风险。
4. What is the most appropriate treatment for this condition?
The primary management decision in patientswith AAAs is either surgery (open or endovascular) or watchful waiting. Allsymptomatic AAAs should be promptly repaired; repair is also recommended forpatients with asymptomatic AAAs that are > 5.5 cm in diameter or have grown0.5 cm within a 6-month period. Patients with smaller aneurysms should bereferred to a vascular specialist and followed by abdominal ultrasound; theyshould be prescribed beta-blockers to control hypertension andcounseled to cease smoking.
4. 这种情况的合适治疗是什么？
对于腹主动脉瘤患者的主要治疗为手术（开放或血管内）或保守观察治疗。所有有症状的腹主动脉瘤患者和动脉瘤直径大于5.5cm以及在六个月内增长大于0.5cm的患者都应该及时治疗。动脉瘤较小的患者应就诊于血管专家并进行腹部超声随访；这些患者应该使用β-受体阻滞剂控制高血压并戒烟。
5. What is the prognosis for this patient overtime?
In a recent trial of about 1000 patients withmedium-sized aneurysms, those who received early elective surgery had significantly better survival ratesthan those who underwent surveillance only. This patient’s prognosis depends onthe size of his aneurysm, rate of growth, blood pressure control, and smokingcessation, as well as the chosen treatment strategy .
5. 这种患者的预后如何？
在近期对1000例中型动脉瘤患者的试验中，尽早接受择期手术治疗的患者存活率较只观察保守治疗的患者较高。这类病人的预后取决于动脉瘤的大小、生长速度、血压的控制、是否戒烟和选择的治疗方案有关。
词 汇
Pack-year：1 pack-year is equal to smoking 20 cigarettes per day for 1 year 一种计算吸烟史的单位,相当于每天20支
Complaint:an illness that affect a part of the body 主诉
Colonoscopy:a visual examination of the colon with a colonoscope 结肠镜
Prostate:anorgan in the body of male mammals situated at the neck of the bladder 前列腺
Aspirin: a medicine that reduces pain, inflammationand fever, In this case, slows clotting of the blood by poisoning platelets 阿司匹林
Metoprolol: beta-blocker used in treatinghypertension and angina and arrhythmia and acute myocardial infarction 美托洛尔
Smoking cessation: cease smoking 戒烟
Vital signs: signs of life 生命体征
Palpate: the process of using one's hands toexamine the body 触诊
Umbilicus: belly button 肚脐
Rupture:state of being tornor burst open 破裂（如动脉瘤破裂）
elective surgery :a surgery that is scheduledin advance because it does not involve a medical emergency. 择期手术
医学英语栏目：以美国执业医师资格考试（USMLE）为主要推送材料，旨在分享医学词汇及临床病例，提高临床医务工作者的英语学习能力与临床业务水平。
如果还有不明白的地方，欢迎后台咨询，科研创新服务平台一定会竭尽全力给你满意的答复。
科研创新服务平台
微信号（lzufreescience）
未经允许 禁止转载
联系客服
