Saladi Lakshmi, Lvovsky Dmitry
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Care Health System, 1650 Grand Concourse, Bronx, NY 10457, USA.
Icahn School of Medicine at Mount Sinai, USA.
Respir Med Case Rep. 2018 May 18;24:165-169. doi: 10.1016/j.rmcr.2018.05.020. eCollection 2018.
Central airway obstruction, a frequently encountered emergency, is usually associated with blood clots, tumors, foreign bodies or mucus plugs. Airway obstruction due to blood clots can be seen as a complication of lung malignancies, infections, bronchiectasis, arteriovenous malformations or pulmonary infarction. In patients with long standing blood clots, the thrombus gets organized and firmly adherent to the airway. The diagnosis is often misleading as these clots mimic tumors clinically and on imaging. Hemoptysis is the most common presenting symptom though many patients can be asymptomatic. Direct visualization with bronchoscopy is required to establish a diagnosis. Life-threatening respiratory impairment is an indication for emergent clot retrieval. Management of these blood clots, especially when organized, is challenging. Initial attempts at removal should include suctioning, lavage or forceps extraction. When unsuccessful, further management options include balloon catheter dislodgement, use of topical thrombolytics, rigid bronchoscopy and cryoextraction.
中央气道阻塞是一种常见的急症，通常与血凝块、肿瘤、异物或黏液栓有关。血凝块导致的气道阻塞可见于肺恶性肿瘤、感染、支气管扩张、动静脉畸形或肺梗死的并发症。在血凝块长期存在的患者中，血栓会机化并牢固附着于气道。由于这些血凝块在临床和影像学上类似肿瘤，诊断往往具有误导性。咯血是最常见的症状，不过许多患者可能没有症状。需要通过支气管镜直接观察来确诊。危及生命的呼吸功能障碍是紧急取出血凝块的指征。这些血凝块的处理，尤其是机化后的血凝块，具有挑战性。最初的清除尝试应包括抽吸、灌洗或用钳子取出。如果不成功，进一步的处理选项包括球囊导管移位、局部使用溶栓剂、硬质支气管镜检查和冷冻取出。
