Murase Kimihiko, Imai Yukihiro, Tachikawa Ryo, Harada Yuka, Seo Ryutaro, Kaji Reiko, Takeshima Yoshimi, Hayashi Michio, Nishimura Takashi, Tomii Keisuke, Katagami Nobuyuki, Ishihara Kyosuke
Department of Respiratory Medicine, Kobe City Medical Center General Hospital.
Nihon Kokyuki Gakkai Zasshi. 2009 Jan;47(1):27-31.
We report an autopsied 33 year old pregnant woman with racemose hemangioma of the bronchial arteries. She was first given a diagnosis of racemose hemangioma of the bronchial arteries at age 19 and underwent surgical ligation. Nevertheless, she had to be admitted to the hospital for bronchial artery embolizations every time hemoptysis recurred. In her 21st gestational week, she was admitted to our hospital because of her 9th recurrent massive hemoptysis and dyspnea. Bronchial artery embolizations were repeatedly performed under intubation to ventilate the healthy left lung separately. We succeeded in temporarily stopping the hemoptysis, but her case was complicated by bacterial pneumonia and septic shock. Her baby was born dead on day 11 and she died on day 12. The autopsy revealed abnormal convoluted and dilated arteries branching from the right intercostal and subclavian arteries and intruding into the lung parenchyma through adhesion caused by her previous thoracostomy. The connections of these abnormal arteries with pulmonary arteries and veins, which had been shown by angiography, were confirmed by autopsy. The autopsy findings suggest that temporal surgical procedures with thoracostomy in this condition can induce abnormal neovascularization via pleural adhesion.
我们报告了一例患有支气管动脉蔓状血管瘤的33岁尸检孕妇。她19岁时首次被诊断为支气管动脉蔓状血管瘤并接受了手术结扎。然而,每次咯血复发时她都不得不因支气管动脉栓塞术入院治疗。在她怀孕第21周时,因第九次反复大量咯血和呼吸困难入住我院。在插管状态下反复进行支气管动脉栓塞术,以便分别对健康的左肺进行通气。我们成功地暂时止住了咯血,但她的病例并发了细菌性肺炎和感染性休克。她的婴儿在第11天死亡,她于第12天去世。尸检发现,异常迂曲和扩张的动脉从右肋间动脉和锁骨下动脉分支,通过她之前开胸手术造成的粘连侵入肺实质。尸检证实了血管造影所显示的这些异常动脉与肺动脉和肺静脉的连接。尸检结果表明,在这种情况下进行的开胸临时手术可通过胸膜粘连诱导异常新生血管形成。