支气管Dieulafoy病一例报告并文献复习

目的提高对支气管Dieulafoy病的认识。方法对1例临床确诊为支气管Dieulafoy病患者的临床资料进行分析，并结合文献复习。结果支气管Dieulafoy病是一种罕见病，以支气管黏膜下畸形的动脉破裂出血为病理特征，其病因及发病机制尚不清楚，可能与支气管肺动脉先天发育异常、气道慢性炎症或损伤有关。临床表现主要为突发大咯血或支气管腔内病灶活检后发生致命性大出血。支气管肺动脉造影是术前诊断的主要手段，手术或尸检标本的组织学检查可以确诊。支气管动脉栓塞可以作为一种治疗方法，但有复发和失败的可能，肺叶切除术可以达到根治目的。结论遇到原因不明的大咯血应注意排除支气管Dieulafoy病的可能；支气管镜检查若发现管腔内突起样病灶，不要盲目活检。     

支气管Dieulafoy病1例

<正>Dieulafoy病是引起消化道大出血的原因之一,该疾病的特征为黏膜下畸形动脉破裂出血。该病由法国医生Dieulafoy 1898年首次报道,多发生于消化系统,而支气管Dieulafoy病则较为罕见,常以致命性大咯血为首发症状[1],在临床上非常容易造成漏诊和误诊。现报道一例于我院近期诊断的支气管Dieulafoy病,以期提高大家对此病的认知及警惕性。临床资料患者女性,63岁,因反复咯血40年余,再发3天入院。40余年前,始无明显诱因反复出现咯血,     

侵袭性肺曲霉病突发坏死物阻塞主气管窒息死亡一例

侵袭性肺曲霉病(invasive pulmonary aspergillosis,IPA),1953年由Rankin[1]首先报道,表现有咳嗽、咳痰、发热、胸膜炎样胸痛及咯血等,如病变广泛时出现气急和呼吸困难,甚至出现呼吸衰竭.曲霉侵袭血管可表现为咯血,大咯血窒息可危及生命[2],但非大咯血引起大气道梗阻窒息死亡的病例报道不多,现报道我院收治的1例IPA突发坏死物质阻塞主支气管窒息死亡病例,以提高临床医生对肺曲霉病并发症的认识.     

支气管Dieulafoy病1例并文献复习

目的 介绍1例支气管Dieulafoy病并复习国内外文献,以提高对这一少见病的认识.方法 对1例确诊为支气管Dieulafoy病患者的临床表现及检查结果进行分析,并结合文献讨论其临床特点、诊断及治疗.结果 支气管Dieulafoy病是一种病因尚未明确的以支气管黏膜下畸形动脉破裂出血为病理特征的罕见疾病,临床常见表现为反...     

支气管动脉瘤误诊为支气管新生物1例并文献复习

正气管动脉瘤(bronchial artery aneurysm,BAA)是一种罕见疾病,多偶然发现,仅1%左右的患者行选择性支气管动脉造影可显示[1]。我院呼吸内科收治1例咯血患者,反复气管镜检查,发现右主支气管开口处新生物,诊断为支气管新生物,行高频电圈套治疗后咯血无好转。支气管动脉造影提示为右侧支气管动脉分支动脉瘤,行支气管动脉栓塞治疗后咯血停止。现报道其诊治经过,同时复习国内     

Dieulafoy病诊断及治疗

Dieulafoy病(Dieulafoy lesion)是Gallard在1884首先描述的,称之为"胃黏膜粟粒样动脉瘤".在1898年,Dieulafoy特征性的将其命名为"浅表性溃疡"[1,2],这种异常也被称为Dieulafoy溃疡、曲张动脉瘤、胃动脉瘤、胃动脉硬化、横径动脉和黏膜下动脉畸形.有报道本病的发病率为0.3%～6.7%[3].所有年龄都可发病,但60岁以上男性多见.     

纤维支气管镜肺活检致大咯血死亡1例

纤维支气管镜肺活检致大咯血死亡１例江开勇患者，男，２５岁，因反复咯血一年在局麻下行纤支镜检查，见右中叶外侧段开口上方外侧壁有一椭圆形突起包块、表面光滑、色泽正常，中央部稍苍白、无搏动征像，在此活检一块后即涌出泡沫样鲜血５００ｍｌ。停止活检、肌注非那根...     

支气管动脉畸形并咯血临床误诊1例分析

正支气管动脉畸形是呼吸系统引起咯血的少见病之一,是呼吸系统疾病急危重症,主要表现为反复发作的大咯血或痰中带血~([1]),如不及时抢救治疗,可因血液淤积窒息而危及患者生命。因支气管动脉畸形仅占咯血原因的2%~([2]),且少部分患者合并支气管扩张或肺结核等能引起咯血的疾病~([3]),往往造成漏诊或误诊,现就我院收治的1例支气管动脉畸形误诊为支气管扩张并咯血患者报道如下。临床资料一、患者郑某,中年男性,因"间断性咯血2年,     

骨化性气管支气管病合并气管黏膜角化症1例

骨化性气管支气管病（TO）是一种少见的、不明原因的、良性的气道疾病,其特征为气管、支气管黏膜下多发骨质或软骨组织结节样增生,并向管腔突起。气管黏膜角化症是一种罕见的气管病变,目前病因及发病机制不明,病理表现为气管黏膜鳞状上皮化生、角化。TO及气管黏膜角化症均较少见,同时合并这两种疾病更为罕见,由于以上两种疾病缺乏典型的...     

支气管动脉栓塞术治疗大血47例分析

目的 进一步探讨支气管动脉栓塞术的治疗选择、复发原因和进展.方法 47例咯血患者接受支气管动脉栓塞术治疗,其中支气管扩张29例,肺结核12例,肺癌2例,肺炎3例,肺隔离症1例,每日咯血＞100 ml的大咯血患者经内科止血治疗无效后,经选择性支气管动脉造影发现出血灶,使用真丝线段等栓塞相应的支气管动脉和参与血供的胸廓内动脉,肋间动脉等.结果 40例栓塞后立即止血,2例反复栓塞＞2次后仍有咯血,3例随防1年,仍有间断少量咯血,1例栓塞术中大咯血窒息经气管插管、机械通气抢救成功,1例咯血再发急诊行左下肺叶切除术.结论 支气管动脉栓塞术是治疗大咯血的一种快速、安全、有效的方法,有效率达85.1%,复发率约为14.8%,复发原因包括血供动静脉畸形,支气管动脉漏栓,栓塞物脱落,原发病进展,造影操作不仔细.而且在栓塞术中要做好抢救准备,特别是病因不明确的咯血要重视,建议先行增强CT扫描或选择性CT造影明确以选择更好的安全治疗手段.我们认为支气管动脉栓塞术栓塞靶血管在2支以上和栓塞物联合栓塞,术中适当灌注止血剂,是提高有效率的办法.     

Right tracheal bronchus with anomalous ramification of the bronchial artery disclosed during an episode of hemoptysis]

A 63-year-old woman was referred to our hospital on June 18th, 1998 during an episode of hemoptysis that had lasted for 6 days. She had no hemorrhagic diathesis and no history of pulmonary disease. Chest X-ray films disclosed a ground-glass opacity in the right upper lung field. Bronchoscopic examination revealed bleeding from an anomalous ectopic orifice on the right lateral trachea, about 1 cm above the carina. Chest computed tomographic examinations by conventional and spiral methods readily disclosed an ectopic bronchus. Bronchial arteriography showed that the tracheal bronchus was fed by a branched vessel of the thyrocervical artery arising from the brachiocephalic artery. Atypical mycobacterium was detected in bronchoalveolar lavage fluid from the ectopic bronchus. A shunt had formed with the pulmonary artery and peripheral parts of the bronchial artery that fed the tracheal bronchus. It was speculated that the hemoptysis in this case might be due to the combined phenomena of infection and abnormal vessel formation in the tracheal bronchus. In our patient, the system of blood supply to the tracheal bronchus may have been a manifestation of atavism because it closely resembled the circulatory structure of the tracheal bronchi normally observed in sheep and giraffes. The tracheal bronchus should be taken into consideration as a potential cause of hemoptysis, inflammatory changes, and atelectasis during intubation.     

Lethal hemoptysis caused by biopsy injury of an abnormal bronchial artery

A 62-year-old man with a long history of lung disease developed atelectasis of the right middle lung lobe, caused by a protrusion in the wall of the middle lobe bronchus. A biopsy was performed in the suspicious region. This was immediately followed by massive arterial bleeding into the airways and complicated by cardiac arrest soon after. The bleeding could not be controlled by nonsurgical treatment; the patient died 24 h after the complication because of pulmonary insufficiency. Autopsy revealed the bleeding to have been caused by a biopsy injury of a bronchial artery that had run superficially in the bronchial mucosa and had produced the intrabronchial protrusion. Several other abnormal intrabronchial arteries were found peripherally in this lung.     

Massive hemoptysis associated with isolated peripheral pulmonary artery stenosis

A fatal case of massive hemoptysis in a patient with isolated peripheral pulmonary artery stenosis is described. Such patients are predisposed to developing pulmonary artery aneurysms. When hemoptysis develops, erosion of an aneurysm into an adjacent bronchus should be considered and aggressive diagnostic evaluation undertaken.     

Vasculo-Behcet's disease with fatal massive hemoptysis]

A 39-year-old man was admitted to our hospital because of hemoptysis. A chest X-ray film on admission showed a patchy shadow in the left lower lung field. Computed tomography revealed nodular opacities in the left pulmonary artery. The patient had history of oral ulcers, erythema nodosum, pustular lesions, and genital ulcers. Furthermore, the needle reaction was positive. Our diagnosis was an incomplete type of Behcet's disease. A radionuclide-venography and lung-perfusion study disclosed deep-vein thrombosis. Combined therapy with prednisolone, colchicine, and indomethacin farnesil was initiated, but the patient died of massive hemoptysis. Pathological examination revealed a ruptured aneurysm in the bronchus segmentalis apacalis and thrombotic angitis in the inferior vena cava. Behcet's disease is rarely a cause of hemoptysis. However, the prevalence of hemoptysis due to pulmonary vasculitis in patients with Behcet's disease has been reported to be 5 to 10% which is not so rare. Because of the poor prognosis, we want to emphasize Behcet's disease as a cause of hemoptysis.     

Primary racemose hemangioma of bronchial artery]

A 38-year-old woman was admitted to the hospital because of massive hemoptysis. A chest X-ray film disclosed an infiltrative shadow. A bronchoscopic examination revealed a small, pulsatile, papillary protrusion in the orifice of the middle lobe bronchus, and massive bleeding from the protrusion was observed during the examination. Bronchial arteriography showed convolution and mild hypervascularization of the right bronchial artery. A middle lobectomy was performed, and the protrusion was histologically shown to be a primary racemose hemangioma of the bronchial artery.     

A case of pulmonary leiomyosarcoma]

A 73-year-old woman with hemoptysis visited our hospital. Chest radiography showed a massive shadow on the right middle lung field. Bronchofiberscopic examination demonstrated a polypoid tumor obstructing the right middle lobe bronchus. A chest CT scan showed that the tumor was situated in the right middle lobe, obstructing the right pulmonary artery trunk. Sarcoma was diagnosed after a CT-guided biopsy. The tumor grew rapidly, giving rise to brain metastasis, which led to the death of the patient. An autopsy examination confirmed the diagnosis as pulmonary leiomyosarcoma.     

Endobronchial capillary hemangioma: a very rare cause of massive hemoptysis

Tracheal capillary hemangioma is a very rare benign tumor of trachea which may present as massive hemoptysis. Minor to massive hemoptysis can be observed in these patients. Due to its small size and tracheal localization, diagnosis cannot be easily performed by using radiological investigations. Fifty-years-old male patient who was diagnosed as tracheal capillary hemangioma with bronchoscopic biopsy was presented in this case report. According to our knowledge, this is the eighth case report in the world literature. Tracheal capillary hemangioma must be kept in mind in patients with massive hemoptysis with normal radiologic features and bronchoscopic procedures (excision, argon, laser etc.) should be the first choice of therapy when diagnosed.     

Two cases of primary racemose hemangioma of the bronchial artery

Two cases of primary racemose hemangioma of the bronchial artery are reported. The first case was admitted because of massive hemoptysis after transbronchial biopsy in another hospital. Bronchoscopic examination revealed a polypoid tumor of the left B4 bronchus, which was resected and diagnosed as racemose hemangioma. The second case was admitted because of massive hemoptysis. Bronchoscopic examination revealed polypoid tumor in the left B3b bronchus, which was resected and diagnosed as racemose hemangioma.