Liu Zhen-Sheng, Li Xiao-Qiang, Li Cheng, Zhou Long-Jiang, Wang Jia-Xiang, Wang Wei, Sun Yong, Kuang Xiong-Wei
Department of Vascular Surgery, the Second Affiliated Hospital of Soochow, Suzhou, China.
Acta Radiol. 2013 Jul;54(6):652-5. doi: 10.1177/0284185113480073. Epub 2013 Apr 30.
Non-bronchial systemic arteries can be a significant source of massive hemoptysis in patients with marked pleural involvement. However, in some cases without pleural involvement, the pulmonary ligament artery (PLA) can also enter the abnormal lung parenchyma and be responsible for hemoptysis.
To discuss the factors influencing the development of a blood supply from the PLA in patients with hemoptysis.
Seventy-five consecutive patients who underwent bronchial artery embolization (BAE) for massive hemoptysis were evaluated between January 2006 and December 2011 retrospectively. Selective arteriography showed an enlarged and tortuous PLA in five patients. CT was done to determine the site and extent of the underlying diseases before BAE in all patients. Angiographic and CT images were analyzed to determine if there was a relationship between PLA supply and location of the underlying disease or mediastinal pleural involvement.
The underlying lesions of six patients involved the basal segments of the lower lobe without marked mediastinal pleural thickening or adhesion, but diaphragmatic and lateral pleural thickening was observed in one case. Of these six patients, the PLA supplied blood to the lesions related to the hemoptysis in five patients. No patient with massive hemoptysis whose underlying lesions involved other segments of lung had a PLA supplying the lesions.
Even though pleural involvement is absent, underlying lesions involving the basal segments of the lower lobe could be a good indicator that the PLA is the cause of bleeding in patients with massive hemoptysis.
在胸膜明显受累的患者中，非支气管性体动脉可能是大量咯血的重要来源。然而，在一些无胸膜受累的病例中，肺韧带动脉（PLA）也可进入异常肺实质并导致咯血。
探讨咯血患者中影响肺韧带动脉供血形成的因素。
回顾性分析2006年1月至2011年12月间连续75例因大量咯血接受支气管动脉栓塞术（BAE）的患者。选择性动脉造影显示5例患者的肺韧带动脉增粗、迂曲。所有患者在接受BAE前均行CT检查以确定基础疾病的部位和范围。分析血管造影和CT图像，以确定肺韧带动脉供血与基础疾病部位或纵隔胸膜受累之间是否存在关联。
6例患者的基础病变累及下叶基底段，无明显纵隔胸膜增厚或粘连，但1例患者可见膈肌和侧胸膜增厚。在这6例患者中，5例患者的肺韧带动脉为与咯血相关的病变供血。基础病变累及肺其他段的大量咯血患者中，无一例有肺韧带动脉为病变供血。
即使没有胸膜受累，基础病变累及下叶基底段也可能是大量咯血患者中肺韧带动脉为出血原因的良好指标。
