Hikmat Fadi, Pearse David B, Damarla Mahendra
Can Respir J. 2014 November/December;21(6):337-340. doi: 10.1155/2014/620542. Epub 2014 Sep 25.
Churg-Strauss syndrome (CSS) is a systemic small-vessel vasculitis. When involving the lungs, small-vessel vasculitides typically cause capillaritis, leading to diffuse alveolar hemorrhage and submassive hemoptysis. In contrast, massive hemoptysis primarily originates from the bronchial arteries; therefore, small-vessel vasculitis is not considered when a patient presents with massive hemoptysis. The authors describe a patient with CSS who presented with the novel finding of massive hemoptysis. Computed tomography scans lacked alveolar infiltrates and bronchoalveolar lavage lacked hemosiderin-laden macrophages. Bronchoscopy demonstrated a raised mucosal lesion in the right mainstem bronchus and computed tomography angiogram revealed aberrant dilated bronchial arteries underlying the same region, suggesting this as the source of the hemoptysis. To the authors' knowledge, the present report describes the first reported case of CSS to present with massive hemoptysis with likely involvement of the bronchial arterial circulation. CSS should be considered in patients with unexplained massive hemoptysis.
变应性肉芽肿性血管炎（CSS）是一种系统性小血管炎。累及肺部时，小血管炎通常导致毛细血管炎，进而引起弥漫性肺泡出血和亚大量咯血。相比之下，大量咯血主要源于支气管动脉；因此，患者出现大量咯血时不考虑小血管炎。作者描述了一名患有CSS的患者，该患者出现了大量咯血这一罕见表现。计算机断层扫描未发现肺泡浸润，支气管肺泡灌洗未发现含铁血黄素巨噬细胞。支气管镜检查显示右主支气管有一个隆起的黏膜病变，计算机断层血管造影显示同一区域有异常扩张的支气管动脉，提示这是咯血的来源。据作者所知，本报告描述了首例有大量咯血且可能累及支气管动脉循环的CSS病例。不明原因大量咯血的患者应考虑CSS。
