Lee Seok Jeong, Lee Jong-Young, Jung Soon Hee, Lee Shun Nyung, Lee Ji-Ho, Kim Chong Whan, Jung Saehyun, Jung Ye-Ryung, Lee Won-Yeon
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Tuberc Respir Dis (Seoul). 2012 Dec;73(6):325-30. doi: 10.4046/trd.2012.73.6.325. Epub 2012 Dec 28.
High-dose-rate endobronchial brachytherapy (HDREB) have been used as the treatment of early endobronchial cancer, as well as for palliation of advanced cancer. However, fatal hemoptysis can occur after HDREB at the rate of 7~32%. We report a case of massive hemoptysis due to radiation bronchitis developed after HDREB. A 67-year-old man was treated with HDREB for early endobronchial cancer on the left upper lobe bronchus. He complained of persistent cough from 4 weeks after completion of HDREB. Radiation bronchitis was observed on the bronchoscopy at 34 weeks, and it was progressed from mucosal swelling and exudate formation to necrosis and ulceration without local relapse. In addition, he died of massive hemoptysis after 15 months. The patient had no sign or radiologic evidences to predict the hemoptysis. This case implies that HDREB directly contributes to an occurrence of a fatal hemoptysis, and follow-up bronchoscopy is important to predict a progression of radiation bronchitis and fatal hemoptysis.
高剂量率支气管内近距离放射治疗（HDREB）已被用于治疗早期支气管癌以及缓解晚期癌症症状。然而，HDREB后致命性咯血的发生率为7%至32%。我们报告一例HDREB后因放射性支气管炎导致大量咯血的病例。一名67岁男性因左上叶支气管早期支气管癌接受HDREB治疗。HDREB完成后4周，他开始出现持续性咳嗽。34周时支气管镜检查发现放射性支气管炎，病变从黏膜肿胀和渗出物形成发展为坏死和溃疡，无局部复发。此外，15个月后他死于大量咯血。该患者没有任何迹象或影像学证据可预测咯血。此病例表明HDREB直接导致了致命性咯血的发生，随访支气管镜检查对于预测放射性支气管炎的进展和致命性咯血很重要。
