Korzan Sophie, Jones Evan, Mutneja Rahul, Grover Prashant
UConn Health, Farmington, CT, USA.
St. Francis Hospital, Hartford, CT, USA.
Respir Med Case Rep. 2018 Mar 23;24:35-39. doi: 10.1016/j.rmcr.2018.03.007. eCollection 2018.
Severe mitral valve stenosis caused by rheumatic heart disease presenting initially as massive hemoptysis has become a rare occurrence in contemporary western medicine. Massive hemoptysis can be due to multiple disease processes including airway diseases such as bronchiectasis, pulmonary parenchymal disease of infectious or autoimmune etiology, pulmonary AVM's, hematologic disorders, and numerous drugs and iatrogenic injuries. It is less associated with congestion from rheumatic heart disease due to the earlier detection and subsequent management of cardiac valve disease preventing the sequela of more severe disease. We describe a case of a 59 year-old woman with hemoptysis, who was found to have severe mitral stenosis consistent with rheumatic heart disease. We demonstrate the appearance of pulmonary venous congestion can be seen on bronchoscopic examination in severe mitral stenosis and discuss the significance of the Wilkins score to help guide management.
风湿性心脏病所致的严重二尖瓣狭窄最初表现为大量咯血，在当代西医中已较为罕见。大量咯血可能由多种疾病过程引起，包括气道疾病如支气管扩张症、感染性或自身免疫性病因的肺实质疾病、肺动静脉畸形、血液系统疾病以及多种药物和医源性损伤。由于心脏瓣膜疾病的早期检测和后续管理可预防更严重疾病的后遗症，因此大量咯血与风湿性心脏病引起的充血关系较小。我们描述了一例59岁咯血女性病例，该患者被发现患有与风湿性心脏病相符的严重二尖瓣狭窄。我们展示了在严重二尖瓣狭窄的支气管镜检查中可看到的肺静脉充血表现，并讨论了威尔金斯评分对指导治疗的意义。
