Department of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois.
Department of Pediatric Pulmonology, Advocate Children's Hospital, Oak Lawn, Illinois.
Pediatr Pulmonol. 2018 Nov;53(11):1504-1509. doi: 10.1002/ppul.24160. Epub 2018 Sep 18.
Hemoptysis in children is an uncommon presenting symptom but can be life-threatening if massive. Cardiac catheterization and coil embolization of aorto-pulmonary collateral vessels (APCs) is uncommon in pediatric hemoptysis patients without congenital heart disease.
We present a series of seven infants (≤12 months of age) with hemoptysis, all of whom underwent cardiac catheterization to look for and intervene upon APCs, if found. Only those patients who underwent both bronchoscopy as well as cardiac catheterization from January 1995 to January 2015 were included in this retrospective review.
Seven patients met inclusion criteria, and three had a history of recurrent hemoptysis. The mean age was 3 months. Four had evidence of bleeding on bronchoscopy. All seven had respiratory distress which necessitated ICU admission; five required mechanical ventilation. Cardiac catheterization showed significant APCs (>2 mm) in six of the seven studied patients, all of which were coil embolized. One patient had no significant APCs and therefore, no embolization. All patients had complete resolution with no recurrences during the 10-20-year outpatient follow-up period. Chest CT scans were not helpful in delineating the site or etiology of bleeding in any patient.
APCs should be considered as a differential diagnosis for pulmonary hemorrhage in infants after more common causes have been ruled out.
儿童咯血是一种不常见的症状，但如果大量咯血则可能危及生命。对于没有先天性心脏病的儿童咯血患者，心导管术和主动脉-肺侧支血管（APCs）的线圈栓塞并不常见。
我们介绍了一系列 7 名患有咯血的婴儿（≤12 个月大），所有这些婴儿都接受了心导管术以寻找和干预 APCs，如果发现的话。只有那些在 1995 年 1 月至 2015 年 1 月期间接受过支气管镜检查和心导管术的患者才被纳入本回顾性研究。
7 名患者符合纳入标准，其中 3 名有反复咯血病史。平均年龄为 3 个月。4 名患者在支气管镜检查时有出血证据。所有 7 名患者均有呼吸窘迫，需要入住 ICU；5 名需要机械通气。心导管术显示 7 名研究患者中有 6 名存在明显的 APCs（>2mm），均采用线圈栓塞。1 名患者没有明显的 APCs，因此无需栓塞。所有患者在 10-20 年的门诊随访期间完全缓解，没有复发。胸部 CT 扫描对任何患者的出血部位或病因都没有帮助。
在排除了更常见的原因后，APCs 应被视为婴儿肺部出血的鉴别诊断。
