Haro M, Jiménez J, Tornero A, Vizcaya M, Tirado R, Cros T
Sección de Neumología, Servicios de Medicina Interna y Radiología, Hospital Universitario Dr. Josep Trueta, Avda. de Francia s/n. 17007 Girona.
An Med Interna. 2002 Feb;19(2):59-65.
We have examined the computed chest tomography (CT) and bronchoscopy utility in diagnosis and accurately identifying the sites of pulmonary bleeding in patients with hemoptysis.
We prospectively reviewed the etiology and the site of bleeding of 482 patients with hemoptysis who had undergone bronchoscopy and CT when we suspected a carcinoma, bronchiectasis or the type of bleeding. We analyzed the age, sex, history of tobacco, bleeding, chest radiography, chest computed tomography and bronchoscopy.
62 years (DS 13.6), 84.4% males, 80% smokers and a volume of bleeding of 42.5 ml/day (DS 89) for 15 days (DS 25). Lung cancer was identified in 43%, bronchiectasis in 20%, chronic obstructive lung disease in 14%, pneumonia 8% and an unknown etiology in only 3%. Bronchoscopy located the site of bleeding in 77% and CT in 83%. When we examine only the lung carcinomas, the chest radiography was normal in 11% and the bronchoscopy was diagnostic in 87%, including 6 cases with a normal CT. Simultaneously chest CT or radiography and bronchoscopy detected all the lung cancers. When the chest radiography was inespecific (32%), CT was diagnostic in 43% and bronchoscopy in 14% (p < 0.001) or localized the site of bleeding in 52% with the CT or 23% with the bronchoscopy (< 0.001).
We concluded that bronchoscopy and CT were useful and complementary in etiologic diagnosis and to localize the site of bleeding in patients with hemoptysis. The bronchoscopy was preferable in patients with a lung cancer and the CT when we studied all the etiologies or the patients without a lung cancer, especially when the radiography was normal. When we simultaneously used a CT or a radiography and the bronchoscopy, all the lung cancers were detected.
我们研究了计算机胸部断层扫描（CT）和支气管镜检查在咯血患者诊断及准确确定肺出血部位方面的效用。
我们前瞻性地回顾了482例咯血患者的病因及出血部位，这些患者在怀疑患有癌症、支气管扩张或出血类型时接受了支气管镜检查和CT检查。我们分析了患者的年龄、性别、吸烟史、出血情况、胸部X线摄影、胸部计算机断层扫描和支气管镜检查结果。
患者平均年龄62岁（标准差13.6），男性占84.4%，吸烟者占80%，每日出血量42.5毫升（标准差89），出血持续15天（标准差25）。43%的患者被诊断为肺癌，20%为支气管扩张，14%为慢性阻塞性肺疾病，8%为肺炎，仅3%病因不明。支气管镜检查确定出血部位的比例为77%，CT为83%。仅检查肺癌患者时，11%的患者胸部X线摄影正常，87%的患者支气管镜检查具有诊断价值，其中6例CT检查正常。胸部CT或X线摄影与支气管镜检查联合可检测出所有肺癌。当胸部X线摄影不具特异性时（32%），CT诊断率为43%，支气管镜检查为14%（p<0.001）；CT确定出血部位的比例为52%，支气管镜检查为23%（<0.001）。
我们得出结论，支气管镜检查和CT在咯血患者的病因诊断及确定出血部位方面均有用且具有互补性。对于肺癌患者，支气管镜检查更具优势；而在研究所有病因或非肺癌患者时，尤其是X线摄影正常时，CT更具优势。当同时使用CT或X线摄影及支气管镜检查时，可检测出所有肺癌。
