Revel Marie Pierre, Fournier Laure S, Hennebicque Anne Sophie, Cuenod Charles Andre, Meyer Guy, Reynaud Philippe, Frija Guy
Department of Radiology, Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France.
AJR Am J Roentgenol. 2002 Nov;179(5):1217-24. doi: 10.2214/ajr.179.5.1791217.
We assessed the capacity of chest radiography and CT to determine the cause and site of bleeding in patients with either large or massive hemoptysis compared with bronchoscopy.
We reviewed the chest radiographs, CT scans, and bronchoscopic findings in 80 patients with either large or massive hemoptysis who were admitted to our intensive care unit between January 1995 and June 1999.
Findings on chest radiography were normal in only 13% of patients, of whom 70% had bronchiectasis. The chest radiographs revealed the site of bleeding in 46% of the patients and the cause in 35%, most of whom had tuberculosis or tumors. CT was more efficient than bronchoscopy for identifying the cause of bleeding (77% vs 8%, respectively; p < 0.001), whereas the two methods were comparable for identifying the site of bleeding (70% vs 73%, respectively; p = not significant).
These data suggest that CT could replace bronchoscopy as the first-line procedure for screening patients with large and those with massive hemoptysis. However, these results must be confirmed in a prospective multicenter study.
我们评估了胸部X线摄影和CT与支气管镜检查相比，确定大量或严重咯血患者出血原因和部位的能力。
我们回顾了1995年1月至1999年6月间入住我们重症监护病房的80例大量或严重咯血患者的胸部X线片、CT扫描和支气管镜检查结果。
仅13%的患者胸部X线摄影结果正常，其中70%患有支气管扩张。胸部X线片显示了46%患者的出血部位，35%患者的出血原因，其中大多数患有结核病或肿瘤。CT在识别出血原因方面比支气管镜检查更有效（分别为77%和8%；p < 0.001），而两种方法在识别出血部位方面相当（分别为70%和73%；p = 无显著性差异）。
这些数据表明，CT可以替代支气管镜检查作为筛查大量和严重咯血患者的一线检查方法。然而，这些结果必须在前瞻性多中心研究中得到证实。
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