Spence T H, Connors J C
Department of Pulmonary and Critical Care Medicine, Missouri Baptist Medical Center, St Louis, USA.
South Med J. 2000 Jan;93(1):65-7.
A variety of clinical diseases are associated with diffuse alveolar hemorrhage. Although mitral valve disease can cause hemoptysis, it rarely is associated with diffuse alveolar hemorrhage at presentation. A 49-year-old woman was admitted to the hospital with the abrupt onset of fever, anemia, dyspnea, azotemia, and diffuse alveolar infiltrates. Two-dimensional echocardiography done several months earlier to evaluate atypical chest pain had been unremarkable. Fiberoptic bronchoscopy 2 days after admission to the hospital revealed fresh blood throughout the tracheobronchial tree. The infiltrates resolved rapidly and completely during systemic steroid therapy only to reappear as the steroids were tapered, suggesting a beneficial therapeutic response. Results of serologic evaluation were negative. Transbronchial biopsies showed inflammation and hemosiderin-laden macrophages; no specific diagnosis was established. The patient was scheduled for open lung biopsy. The surgeon was concerned about the history of chest pain and requested placement of a pulmonary artery catheter, which revealed severe pulmonary hypertension. Transesophageal echocardiography and subsequent cardiac catheterization showed severe mitral regurgitation. Mitral valve replacement resulted in complete elimination of symptoms.
多种临床疾病与弥漫性肺泡出血相关。虽然二尖瓣疾病可导致咯血，但在发病时很少与弥漫性肺泡出血相关。一名49岁女性因突然出现发热、贫血、呼吸困难、氮质血症和弥漫性肺泡浸润而入院。几个月前为评估非典型胸痛而进行的二维超声心动图检查未见异常。入院2天后的纤维支气管镜检查显示整个气管支气管树均有新鲜血液。在全身使用类固醇治疗期间，浸润迅速且完全消退，但随着类固醇逐渐减量又再次出现，提示治疗反应良好。血清学评估结果为阴性。经支气管活检显示有炎症和含铁血黄素巨噬细胞；未确立明确诊断。患者计划进行开胸肺活检。外科医生因胸痛病史而担心，并要求放置肺动脉导管，结果显示有严重肺动脉高压。经食管超声心动图及随后的心导管检查显示有严重二尖瓣反流。二尖瓣置换术后症状完全消失。
