Matsushima Hidekazu, Oda Toshimi, Sato Akira, Yamamoto Masayuki, Hasejima Nobuchika, Kadoyama Chikabumi, Takezawa Shinji
Department of Respiratory Medicine, Saitama Red Cross Hospital.
Nihon Kokyuki Gakkai Zasshi. 2009 Jan;47(1):61-5.
A 53-year-old woman was admitted to our hospital complaining of repeated hemoptysis. Her past history indicate uveitis at age 48. Chest HRCT findings showed the thickening of broncho-vascular bundles, interlobular septal thickening, and patchy ground-glass attenuation, but no hilar and mediastinal lymphadenopathy. BALF and TBLB were not diagnostic. Her hemoptysis was persistent, and we performed VATS biopsy, which revealed diffuse epithelioid cell granulomas with multinucleated giant cells along vessels and intra-alveolar spaces, consistent with sarcoidosis. Sarcoidosis was therefore diagnosed. She was treated with steroids, and her CT findings improved, but her hemoptysis was persistent. Bronchial artery angiography revealed micro-aneurysms in the left bronchial artery and shunt to the pulmonary vein form the right bronchial artery. We decided that the etiology of her hemoptysis was from micro-aneurysms in the left bronchial artery. We concluded that hemorrhage from vascular lesions, including the bronchial artery, could be complications in cases of sarcoidosis.
一名53岁女性因反复咯血入院。她既往有48岁时患葡萄膜炎的病史。胸部高分辨率CT(HRCT)表现为支气管血管束增厚、小叶间隔增厚和斑片状磨玻璃影,但无肺门及纵隔淋巴结肿大。支气管肺泡灌洗(BALF)和经支气管肺活检(TBLB)均未明确诊断。她的咯血持续存在,我们进行了电视辅助胸腔镜手术(VATS)活检,结果显示沿血管和肺泡腔内有弥漫性上皮样细胞肉芽肿及多核巨细胞,符合结节病表现。因此诊断为结节病。她接受了类固醇治疗,CT表现有所改善,但咯血仍持续。支气管动脉造影显示左支气管动脉有微动脉瘤,右支气管动脉向肺静脉分流。我们判定她咯血的病因是左支气管动脉微动脉瘤。我们得出结论,包括支气管动脉在内的血管病变出血可能是结节病的并发症。