患儿，男，20 d，因生后呼吸困难20 d入院。临床主要表现为生后逐渐出现呼吸困难、水肿等症状，予有创呼吸机辅助通气、利尿等治疗。心脏超声提示全心大，肺动脉高压，心功能不全。全身详细体格检查后发现，前囟及双侧颞部听诊可闻及明显吹风样血管杂音，完善头颅磁共振成像+磁共振血管成像+磁共振静脉成像检查见上矢状窦、横窦、乙状窦明显扩张，诊断硬脑膜动静脉瘘，多学科会诊讨论后行全脑血管造影术+左顶叶动静脉瘘部分栓塞术，术后予强心、利尿、限制液体量等治疗，最终患儿撤离呼吸机，好转出院。该文报道1例以呼吸困难起病的新生儿硬脑膜动静脉瘘，以及对该疾病的多学科诊疗，有助于早期识别疾病和指导临床决策。
Abstract
The patient, a 20-day-old male, was admitted due to respiratory distress that had persisted for 20 days after birth. The main clinical manifestations included gradually worsening respiratory distress and edema. The patient received treatment including mechanical ventilation and diuretics. Echocardiography indicated cardiomegaly, pulmonary hypertension, and heart failure. A comprehensive systemic examination revealed a significant blowing vascular murmur upon auscultation over the anterior fontanelle and bilateral temporal regions. Further imaging studies including cranial magnetic resonance imaging, magnetic resonance angiography, and magnetic resonance venography showed marked dilation of the superior sagittal sinus, transverse sinus, and sigmoid sinus, leading to a definitive diagnosis of dural arteriovenous fistula. After a multidisciplinary consultation, the patient underwent cerebral angiography and partial embolization of the left parietal arteriovenous fistula. Postoperatively, the patient was treated with positive inotropes, diuretics, and fluid restriction. Ultimately, the patient was weaned off the ventilator and discharged in improved condition. This article reports a case of neonatal dural arteriovenous fistula presenting with respiratory distress and discusses the multidisciplinary approach to managing this condition, which aids in early disease recognition and guides clinical decision-making.
关键词
硬脑膜动静脉瘘 /
呼吸困难 /
心力衰竭 /
肺动脉高压 /
新生儿
Key words
Dural arteriovenous fistula /
Respiratory distress /
Heart failure /
Pulmonary hypertension /
Neonate
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参考文献
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