纤维支气管镜检查对老年咯血患者的诊断价值

目的 评估纤维支气管镜检查对老年咯血患者的诊断价值及安全性。方法 采用回顾性方法收集经纤维支气管镜检查的126例老年咯血患者，并结合临床进行对照分析。结果 126例老年咯血患者诊断肺癌49例（38．8％）、慢性炎症45例（35．7％），结核16例（12．6％），支气管扩张9例（7．14％），原因不明7例（5．55％）。结论 纤维支气管镜检查是老年咯血的病因诊断及出血定位诊断的重要手段，但需掌握适应症。     

纤维支气管镜检查对老年人不典型肺结核的诊断价值

目的评价支气管镜术对老年人不典型肺结核的诊断价值。方法对５１例老年不典型肺结核患者在纤维支气管镜直视下获取标本进行病理学和细菌学检查。结果刷检直接涂片和支气管肺泡灌洗液经离心浓集涂片同时找到抗酸杆菌２７例（５２．９％）；活检经病理学检查呈结核病变８例（１５．８％）；刷检７例（１３．７％）、支气管肺泡灌洗液４例（７．８％）、吸引物３例（５．９％）及术后痰检２例（３．９％）分别找到抗酸杆菌。结论纤维支气管镜检查对老年人不典型肺结核的诊断具有重要价值     

纤维支气管镜检查的严重并发症调查

目的了解上海地区纤维支气管镜（纤支镜）检查发生严重并发症的情况。方法对上海２１家医院采用问卷式调查。结果经纤支镜检查８０９９８例次，发现死亡６例（０．７／万），大咯血７８例（９．６／万），并发症发生率略低以前报告。结论认为与技术成熟及防范意识加强有关。     

纤维支气管镜检查对单纯咳嗽咯血病人的诊断价值

本文报告纤维支气管镜（纤支镜）对单纯咯血及刺激性咳嗽而无肺部Ｘ线异常阴影的诊断价值。６５例病人经刷检，活检及支气管肺泡灌洗（ＢＡＬ）检查结果与随访半年的结果比较，显示纤支镜检对肺癌的及时诊断率为８５．７％，支气管结核为８０．０％。说明纤支镜检同时进行刷检活检和ＢＡＬ液检查，对提高检出率的重要性。     

390例胸片无明显异常的咯血患者纤维支气管镜分析

对390例咯血而胸片大致正常进行了纤维支气管镜（纤支镜）检查。发现肺癌检出率为4．1％。其中＞40岁、重度吸烟及以痰血为表现分别高于40岁以下、不吸烟及大口咯血（P＜0．005）。认为年逾40岁、重度吸烟、以痰血为主要表现的新近咯血并经积极治疗两周无效的患是纤支镜检查的适应证。     

经皮粗针活检对肺肿块的诊断价值

本文对２３例纤维支气管镜（纤支镜）检查阴性，与胸壁不同距离的肺内肿块做经皮粗针肺活检，结果有２２例获明确诊断（９５．７％）；经皮粗针活检中有３例发生咯血、１例剧烈胸痛、３例并发无临床表现的气胸。表明经皮粗针肺活检对纤支镜检查阴性的肺肿块有较高的诊断率，而并发症轻微。     

糖尿病合并肺结核60例分析

１９８７年￣１９９７年住院４６４例肺结核病人中，６０例（１２．９％）伴有糖尿病，采用回顾性分析方法，分析糖尿病合并肺结核的临床特点及治疗情况。结果表明：≥５０岁者４５例（７５％），Ⅱ型糖尿病者５５例（９１．７％），以咳嗽、咯痰、发热、消瘦、乏力、咯血为主要临床表现，８３．３％为患糖尿病后伴发肺结核，其起病急骤、病情较重，胸Ｘ线片以斑片状影为主３１例（５１．７％），下肺结核１２例（２０％），抗结核治     

咯血的纤维支气管镜检查

咯血的纤维支气管镜检查潘顺全，王开明，沈曾敏，李琴芳我院自１９８５年５月～１９８９年１０月对２６７例咯血病人进行了纤维支气管镜（纤支镜）检查，结合病理、Ｘ线表现和选择性支气管造影进行分析。病例选择：１．排除肺外疾病及上呼吸道病变所致的咯血；２．咯血量...     

X线胸片无异常咯血患者纤维支气管镜检查结果分析

1998年1月-2008年12月,我们对112例x线胸片无异常咯血患者行纤维支气管镜（纤支镜）检查,明确诊断85例,纤支镜诊断率达75．9％,结果较满意,现报告如下。     

纤维支气管镜检查对单纯咳嗽咯血病人的诊断价值

本文报告纤维支气管镜对单纯咯血及刺激性咳嗽及无肺部Ｘ线异常阴影的诊断价值。６５例病人经刷检，活检及支气管肺泡灌洗检查结果与随访半年的结果比较，显示纤支镜检对肺癌的及时诊断率为８５．７％，支气管结核为８０．０％。说明纤支镜检同时进行刷检活检和ＢＡＬ液检查，对提高检出率的重要性。     

纤维支气管镜对胸片正常咯血患者的诊断价值

目的 探讨胸部X线检查正常的咯血患的病因。方法 通过纤维支气管镜检查确定142例胸部X线检查正常的咯血患的病因。结果 142例患中,110例（77.46%）患通过纤支镜检查确定病因,其中炎症88例（61.97%）,肺癌16例（11.27%）,支气管内膜结核6例（4.22%）。结论 纤支镜对确定胸片正常的咯血患的病因有重要作用。     

A prospective evaluation of hemoptysis cases in a tertiary referral hospital

Background and Aims: Hemoptysis is symptomatic of a potentially serious and life‐threatening thoracic disease. The purpose of this study was to evaluate the relative frequency of the different causes of hemoptysis, the change of the frequency of diseases, the value of the evaluation process and the outcome in a tertiary referral hospital. Methods: A prospective study was carried out on consecutive patients presented with hemoptysis. Results: A total of 178 patients (136 male, 42 female) were included to the study. Lung cancer (51), pulmonary embolism (23) and bronchiectasis (23) constituted most of the diagnosis. The most frequent cause of hemoptysis in males was by far lung carcinoma (50). Twelve cases of bronchiectasis and 11 cases of pulmonary embolism were observed in females. While lung cancer and pulmonary embolism were associated with mild to moderate amounts of bleeding (84% and 100%, respectively), patients with active tuberculosis and pulmonary vasculitis had severe to massive hemoptysis (50% and 44%, respectively). Transthoracic and other organ biopsies, spiral computed tomography (CT) angiography (X pres/GX model TSX‐002a, Toshiba, Tochigi Ken, Japan) and aortography yielded high diagnostic results in our group (100%, 67%, 59% and 100%, respectively). The most frequent final diagnosis in patients with normal chest radiograph was pulmonary embolism (seven cases). Conclusions: Lung cancer, pulmonary embolism and bronchiectasis were the main causes of hemoptysis in this prospective cohort; however, this is the first report showing pulmonary embolism as a leading cause of hemoptysis. CT angiography with high‐resolution CT should be the primary diagnostic modality if the initial investigation is inconclusive in hemoptysis cases. Please cite this paper as: Uzun O, Atasoy Y, Findik S, Atici AG and Erkan L. A prospective evaluation of hemoptysis cases in a tertiary referral hospital. The Clinical Respiratory Journal 2010; 4: 131–138.     

A case of endobronchial minute leiomyoma and literature review of the 66 cases of endotracheal and endobronchial leiomyoma reported in Japan]

A case of endobronchial minute leiomyoma successfully treated by bronchoscopically directed forceps biopsy is described. A 42-year-old male with a 20 pack-year smoking history was admitted for dry cough occurring at night. Chest X-ray showed no abnormal shadows. The tumor, measuring 2 by 2 mm, was located in the right B7. The clinical characteristics of the 66 cases of endotracheal and endobronchial leiomyoma reported in Japan are also discussed. The male to female ratio of this disease was 2:3. Middle-aged people were most, commonly affected. Usually, obstructive pneumonia or atelectasis, which develops distal to the lesion, causes respiratory symptoms and chest X-ray abnormality. However, 10% of cases were asymptomatic and 30% had a negative chest X-ray. There were 7 cases of endobronchial minute leiomyoma, measuring less than 10 mm in diameter. Of these, three cases had only hemoptysis and had no chest X-ray abnormality. In such cases fiberoptic bronchoscopy is may be the only useful procedure for the diagnosis of this disease.     

Role of computed tomography in patients with hemoptysis and a normal chest skiagram

Thirty patients of hemoptysis with a normal skiagram chest were evaluated by computed tomography. Majority of the patients were between 21 to 50 years of age. Seventy percent had mild hemoptysis while 30 percent had moderate hemoptysis. Computed tomography provided diagnostic information in 16 patients (53%). The various aetiologies were bronchiectasis (20%), tuberculosis (20%), pneumonia (6.7%), bronchial carcinoid in one case and allergic bronchopulmonary aspergillosis in one case. Computed tomography may play a role in screening patients who present with hemoptysis with normal chest radiographs.     

A prospective analysis of 184 hemoptysis cases: diagnostic impact of chest X-ray, computed tomography, bronchoscopy

BACKGROUND: The clinical presentation of hemoptysis often raises a number of diagnostic possibilities. OBJECTIVES: This study was designed to evaluate the relative frequency of different causes of hemoptysis and the value of chest radiography, computed tomography (CT) scanning and fiber-optic bronchoscopy in the evaluation of a Greek cohort population. METHODS: We prospectively followed a total of 184 consecutive patients (137 males/47 females, 145 smokers/39 nonsmokers) admitted with hemoptysis between January 2001 and December 2003 to the University Hospital of Heraklion. Follow-up data were collected on August 2005. RESULTS: The main causes of hemoptysis were bronchiectasis (26%), chronic bronchitis (23%), acute bronchitis (15%) and lung cancer (13%). Bronchiectasis was significantly more frequent in nonsmokers (p < 0.02). Among nonsmokers, patients with moderate/severe bleeding or a history of tuberculosis were more likely to have bronchiectasis (OR 8.25; 95% CI 1.9-35.9, p = 0.007 and OR 16.5; 95% CI 1.7-159.1, p = 0.007, respectively). Nonsmokers with normal or abnormal X-rays were equally likely to have bronchiectasis (OR 2.5; 95% CI 0.66-9.39, p = 0.2). Lung cancer was only found in smokers. Smokers with normal X-rays were less likely to have lung cancer compared to smokers with abnormal X-ray (OR 5.4; 95% CI 1.54-19.34, p = 0.004). There were no smokers with normal CT and lung cancer. Follow-up data were collected in 91% of patients. Lung cancer did not develop in any patient assumed to have hemoptysis of another origin than lung cancer on initial evaluation. CONCLUSIONS: Bronchiectasis is the main diagnosis in patients admitted with hemoptysis to a Greek University Hospital and it is more frequent among nonsmokers with moderate/severe bleeding and/or previous tuberculosis infection. Nonsmokers with moderate/severe hemoptysis and/or a history of tuberculosis should be evaluated with high-resolution CT. Smokers with hemoptysis are at increased risk for lung cancer and need to be extensively evaluated with chest CT and bronchoscopy.     

肺结核患者咯血责任血管及其相关胸部CT表现的分析

目的分析肺结核患者咯血责任血管及其相关胸部CT表现,以期提高支气管动脉介入栓塞(BAE)的治疗效果。方法收集我院2017年10月至2020年10月在本院行胸部CTA及BAE治疗的94例患者的临床及影像资料。总结肺结核不同胸部CT表现与咯血责任血管之间的关系。结果94例患者经CTA检查共发现187支咯血责任血管,其中支气管动脉(BA)124支,非支气管性体动脉(NBSA)63支(多位于肋间动脉及锁骨下动脉);DSA发现咯血责任血管192支,以DSA为诊断“金标准”,CTA对咯血责任血管的检出率为97.4%;35例(占37.2%)病灶周围可见支气管动脉分支局限性迂曲、扩张,供血支气管动脉平均内径为(2.0±0.7)mm;肺结核伴咯血患者胸部CT发现病灶多位于多肺叶,病灶以弥漫性分布为主,多无胸腔积液,此外伴空洞、钙化、支气管扩张及淋巴结钙化等,均与咯血责任血管来源无明显相关性(P>0.05),病灶性质、胸膜增厚程度及结核病灶与增厚胸膜之间关系与咯血责任血管来源明显相关(P<0.05),其中咯血责任血管来源于BA的肺结核伴咯血患者,病灶病变以增殖、渗出为主,邻近胸膜增厚程度多较轻微或没有增厚且增厚胸膜无或轻度黏连者居多,而咯血责任血管来源于BA合并NBSA的肺结核伴咯血患者肺部病变以纤维化为主,邻近胸膜增厚明显,且肺部病灶与增厚胸膜紧密粘连者居多。结论肺结核伴咯血胸部CT表现与咯血责任血管来源关系紧密,可通过胸部CT表现提示咯血责任血管是否源于NBSA,可帮助提高BAE的治疗效果。     

肺结核患者咯血责任血管及其相关胸部CT表现的分析

目的分析肺结核患者咯血责任血管及其相关胸部CT表现,以期提高支气管动脉介入栓塞(BAE)的治疗效果。方法收集我院2017年10月至2020年10月在本院行胸部CTA及BAE治疗的94例患者的临床及影像资料。总结肺结核不同胸部CT表现与咯血责任血管之间的关系。结果94例患者经CTA检查共发现187支咯血责任血管,其中支气管动脉(BA)124支,非支气管性体动脉(NBSA)63支(多位于肋间动脉及锁骨下动脉);DSA发现咯血责任血管192支,以DSA为诊断“金标准”,CTA对咯血责任血管的检出率为97.4%;35例(占37.2%)病灶周围可见支气管动脉分支局限性迂曲、扩张,供血支气管动脉平均内径为(2.0±0.7)mm;肺结核伴咯血患者胸部CT发现病灶多位于多肺叶,病灶以弥漫性分布为主,多无胸腔积液,此外伴空洞、钙化、支气管扩张及淋巴结钙化等,均与咯血责任血管来源无明显相关性(P>0.05),病灶性质、胸膜增厚程度及结核病灶与增厚胸膜之间关系与咯血责任血管来源明显相关(P<0.05),其中咯血责任血管来源于BA的肺结核伴咯血患者,病灶病变以增殖、渗出为主,邻近胸膜增厚程度多较轻微或没有增厚且增厚胸膜无或轻度黏连者居多,而咯血责任血管来源于BA合并NBSA的肺结核伴咯血患者肺部病变以纤维化为主,邻近胸膜增厚明显,且肺部病灶与增厚胸膜紧密粘连者居多。结论肺结核伴咯血胸部CT表现与咯血责任血管来源关系紧密,可通过胸部CT表现提示咯血责任血管是否源于NBSA,可帮助提高BAE的治疗效果。     

肺泡微石症3例并文献复习

目的加强对肺泡微石症的认识,提高其诊断率。方法通过中国生物医学文献光盘数据库(CBM-Disk)检索1994年1月至2010年5月有关报道肺泡微石症的文献,剔除重复累计报道病例,结合本院收治的3例,回顾性分析中国人肺泡微石症的临床资料。结果共报道了120例肺泡微石症,男70例(58.3％),女50例(41.7％)。有临床症状者65例,主要表现为咳嗽51例(42.5％)、气促49例(40.8％)、咯痰26例(21.7％)、胸痛18例(15.0％)、胸闷17例(14.2％)、心悸4例(3.3％)、咯血3例(2.5％)。无症状者55例。肺功能检查22例,7例正常,12例呈限制性通气功能障碍,弥散功能下降。120例均行胸部X线检查,显示双肺粟粒影106例,其中92例中下肺粟粒影增加,病灶聚集融合41例,肺门正常104例,心膈模糊55例,线状钙化48例,肺尖气肿1例。结论我国肺泡微石症较为少见,临床症状无特异性,易漏诊、误诊。对可疑患者应及早行胸部高分辨率CT及纤维支气管镜肺活检以确诊。     

The utility of routine admission chest X-ray films on patient care

Background

Routine chest X-rays are the most widely obtained radiological studies during hospital admissions. In this study, we evaluated the utility of routine admission chest X-rays on patient care in patients admitted to The Brooklyn Hospital center.

Methods

We included consecutive patients admitted to the medical floors during a 4-month period who had a chest X-ray done on admission. The medical records of patients who had chest X-ray on admission were reviewed to identify any impact of chest X-ray on patient care during the course of hospitalization.

Results

Chest X-ray was noted to be done in 229 patients on admission. Chest X-rays of 100 (43.6%) patients were deemed medically necessary because of the presenting complaints which included cough (15.2%), fever (13.1%), dyspnea (6.1%), hemoptysis (1.7%), and combined symptoms (7.4%). Routine chest X-rays were done in 129 (56.3%) patients to rule out occult findings in the absence of any symptoms. Chest X-ray abnormalities were noted in 56 of 129 (43.4%) patients. In 51 of 56 patients, abnormalities were chronic, stable and previously known and did not contribute to patient care. In only 5 of 129 (3.87%) patients, there were findings which necessitated a change in patient care.

Conclusion

We conclude that routine chest films rarely reveal clinically unsuspected findings. The overall impact on patient care based on these findings is small when compared to the risks associated with repeated exposure to radiation. We recommend that routine chest X-ray films should not be ordered solely because of hospital admission.     

Analysis of patients with hemoptysis in a reference hospital for chest diseases

Chest physicians frequently come across with the symptom hemoptysis, an alerting symptom which may result from a wide variety of disorders. In this study, we aimed to determine the main causes of hemoptysis in a reference hospital for chest diseases. All the patients who admitted to our emergency clinic with hemoptysis during three months of study period were included in the study. The mean age of 143 patients (106 males, 37 females) who were included in this study was 48 +/- 17 years. Medical history, physical examination and chest radiography were performed for each patient. Sputum examination for acid fast bacilli, computed tomography of thorax, fiberoptic bronchoscopy, ventilation-perfusion scintigraphy, echocardiography, ear-nose-throat examination and upper gastrointestinal system endoscopy were the further diagnostic investigations for selected patients. Bronchiectasis was the most common cause of hemoptysis (22.4%), followed by lung cancer (18.9%), active tuberculosis (11.2%), and inactive tuberculosis (10.5%). Sputum smear for acid fast bacilli was performed in 102 patients and were positive in 15.6% of them. Computed tomography of thorax was performed in 102 patients and was pathologic in 81.3% of them. Fiberoptic bronchoscopy was performed in 46 patients and localized the bleeding site in 67.4% of them. In conclusion, the most common causes of hemoptysis were bronchiectasis, lung cancer and tuberculosis in our hospital. Based on this finding, we suggest that, the diagnostic approach to the patients presenting with hemoptysis should include first a detailed medical history, physical examination, and chest radiography; second sputum smear for acid fast bacilli; third computed tomography of thorax and lastly fiberoptic bronchoscopy.