Kuraishi Hiroshi, Yano Ryozo, Hasumoto Makoto, Kasai Tomihiko, Kikuchi Toshiki, Tomita Shogo, Otsuka Hidehiko, Akizawa Takanori, Narushima Michiaki, Suzuki Hajime, Suzuki Shuichi, Suzuki Takashi
Department of Respiratory Internal Medicine, Showa University Fujigaoka Hospital.
Nihon Kokyuki Gakkai Zasshi. 2006 May;44(5):415-9.
We report two cases of bilateral racemose hemangioma in patients with hemoptysis. Case 1 was a 62-year-old woman who visited a local clinic complaining of hemoptysis. Bronchoscopy revealed multiple pulsating tumorous lesions and she was referred to our department. Chest Multidetector CT (MDCT) disclosed bilateral enlarged and convoluted, abnormal bronchial arteries and primary racemose hemangioma was diagnosed. Bronchial artery embolization was selected, but not conducted because of concern regarding the arteriovenous shunt and escape into the greater circulation. In combination with thoracoscopic mini-thoracotomy, ligation and separation of the bronchial artery were performed. Case 2 was a 68-year-old man who was transferred to our department with a chief complaint of hemoptysis. MDCT revealed bilateral bronchiectasis and a convoluted and enlarged, abnormal bronchial artery along the mediastinum. He was diagnosed as having secondary racemose hemangioma. First, bronchial artery embolization was conducted, but hemostasis was difficult, thus surgical ligation was conducted. In both cases, MDCT was effective for diagnosis and surgical ligation is very important as a therapeutic option for racemose hemangioma.
我们报告了两例咯血患者的双侧蔓状血管瘤病例。病例1是一名62岁女性,因咯血前往当地诊所就诊。支气管镜检查发现多个搏动性肿瘤病变,随后她被转诊至我科。胸部多层螺旋CT(MDCT)显示双侧支气管动脉增粗、迂曲,诊断为原发性蔓状血管瘤。考虑到动静脉分流及进入体循环的风险,选择了支气管动脉栓塞术,但未实施。结合电视胸腔镜小切口开胸手术,进行了支气管动脉结扎和分离。病例2是一名68岁男性,因咯血为主诉转入我科。MDCT显示双侧支气管扩张,沿纵隔有一条迂曲、增粗的异常支气管动脉。他被诊断为继发性蔓状血管瘤。首先进行了支气管动脉栓塞术,但止血困难,因此进行了手术结扎。在这两个病例中,MDCT对诊断有效,手术结扎作为蔓状血管瘤的一种治疗选择非常重要。