Basille D, Andréjak C, Gosset M, Renard C, Jounieaux V
Service de pneumologie et réanimation respiratoire, CHU d'Amiens, avenue Laënnec, 80054 Amiens cedex 1, France.
Rev Mal Respir. 2010;27(1):63-6. doi: 10.1016/j.rmr.2009.11.009. Epub 2009 Dec 14.
The incidence of pulmonary tuberculosis is actually increasing. In active tuberculosis, an aneurysm of the pulmonary artery represents a frequent cause of haemoptysis. In cases of tuberculosis sequelae, the origin of the haemoptysis is often a bronchial artery.
We describe the case of a man from Morocco who presented with severe haemoptysis. He was cachectic, had a fever and his chest X-ray showed a cavity in the left lower lobe. CT angiography (MDCTA) showed a Rasmüssen aneurysm of the pulmonary artery. This was occluded with coils, and multi-drug therapy against Mycobacterium tuberculosis was initiated as soon as tuberculosis was diagnosed. Two months later, there was no recurrence of the haemoptysis and repeat the MDCTA showed no opacification of the aneurysm.
In patients with severe haemoptysis and evidence of active pulmonary tuberculosis, MDCTA may allow correct identification of the bleeding origin. In our case, the management of the pulmonary aneurysm relied upon pulmonary artery vasoocclusion. This treatment allowed us to wait for the antituberculosis treatment to be effective and reduces the need for a thoracic surgery.
肺结核的发病率实际上在上升。在活动性肺结核中，肺动脉瘤是咯血的常见原因。在肺结核后遗症病例中，咯血的根源通常是支气管动脉。
我们描述了一名来自摩洛哥的男子，他出现严重咯血。他消瘦、发热，胸部X光显示左下叶有一个空洞。CT血管造影（MDCTA）显示肺动脉有一个拉斯穆森动脉瘤。用弹簧圈将其闭塞，一旦诊断出肺结核，就立即开始针对结核分枝杆菌的多药治疗。两个月后，咯血未复发，重复MDCTA显示动脉瘤无造影剂充盈。
对于有严重咯血且有活动性肺结核证据的患者，MDCTA可能有助于正确识别出血来源。在我们的病例中，肺动脉瘤的治疗依靠肺动脉血管闭塞术。这种治疗方法使我们能够等待抗结核治疗起效，并减少了胸外科手术的必要性。
