Uzun Oğuz, Atasoy Yildiz, Findik Serhat, Atici Atilla Güven, Erkan Levent
Deparment of Pulmonary Medicine, Ondokuz Mayis University, Samsun, Turkey.
Clin Respir J. 2010 Jul;4(3):131-8. doi: 10.1111/j.1752-699X.2009.00158.x.
Hemoptysis is symptomatic of a potentially serious and life-threatening thoracic disease. The purpose of this study was to evaluate the relative frequency of the different causes of hemoptysis, the change of the frequency of diseases, the value of the evaluation process and the outcome in a tertiary referral hospital.
A prospective study was carried out on consecutive patients presented with hemoptysis.
A total of 178 patients (136 male, 42 female) were included to the study. Lung cancer (51), pulmonary embolism (23) and bronchiectasis (23) constituted most of the diagnosis. The most frequent cause of hemoptysis in males was by far lung carcinoma (50). Twelve cases of bronchiectasis and 11 cases of pulmonary embolism were observed in females. While lung cancer and pulmonary embolism were associated with mild to moderate amounts of bleeding (84% and 100%, respectively), patients with active tuberculosis and pulmonary vasculitis had severe to massive hemoptysis (50% and 44%, respectively). Transthoracic and other organ biopsies, spiral computed tomography (CT) angiography (X pres/GX model TSX-002a, Toshiba, Tochigi Ken, Japan) and aortography yielded high diagnostic results in our group (100%, 67%, 59% and 100%, respectively). The most frequent final diagnosis in patients with normal chest radiograph was pulmonary embolism (seven cases).
Lung cancer, pulmonary embolism and bronchiectasis were the main causes of hemoptysis in this prospective cohort; however, this is the first report showing pulmonary embolism as a leading cause of hemoptysis. CT angiography with high-resolution CT should be the primary diagnostic modality if the initial investigation is inconclusive in hemoptysis cases.
咯血是潜在严重且危及生命的胸部疾病的症状。本研究的目的是评估一家三级转诊医院中咯血不同病因的相对频率、疾病频率的变化、评估过程的价值及结果。
对连续出现咯血症状的患者进行前瞻性研究。
本研究共纳入178例患者（男性136例，女性42例）。肺癌（51例）、肺栓塞（23例）和支气管扩张（23例）构成了大部分诊断结果。男性咯血最常见的原因是肺癌（50例）。女性观察到12例支气管扩张和11例肺栓塞。肺癌和肺栓塞与轻度至中度出血相关（分别为84%和100%），而活动性肺结核和肺血管炎患者有严重至大量咯血（分别为50%和44%）。经胸及其他器官活检、螺旋计算机断层扫描（CT）血管造影（X pres/GX型号TSX - 002a，日本东芝公司，栃木县）和主动脉造影在我们组中产生了较高的诊断结果（分别为100%、67%、59%和100%）。胸部X线片正常的患者中最常见的最终诊断是肺栓塞（7例）。
肺癌、肺栓塞和支气管扩张是该前瞻性队列中咯血的主要原因；然而，这是首次报告显示肺栓塞是咯血的主要原因。如果咯血病例的初步检查结果不明确，高分辨率CT血管造影应作为主要诊断方式。
