Chen Wenfang, Chen Pingping, Li Xiuyu, Gao Xinglin, Li Jing
Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangdong Geriatrics Institute, Shantou University Medical College, Guangdong, 510080, China.
Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangdong Geriatrics Institute, Guangdong, 510080, China.
Respir Med Case Rep. 2019 Jan 7;26:229-235. doi: 10.1016/j.rmcr.2019.01.004. eCollection 2019.
Dieulafoy's disease of the bronchus is an arterial abnormality characterized by enlarged mucosal arterial branches that are susceptible to lethal bleeding. To date, this disease is rarely reported in the literature. We recently encountered three patients from February 2010 to March 2017, each with such a vascular anomaly in a bronchus with massive hemoptysis.
This paper describes the clinical characteristics and treatments for Dieulafoy's disease.
We report three cases with recurrent massive hemoptysis. Bronchoscopic examination was performed on two patients, one with a non-pulsating polypoid nodule and the other without. One patient had fatal bleeding after biopsy and could not withstand bronchial artery embolization or thoracotomy. Angiography and bronchial artery embolization on another two patients successfully stopped the bleeding. In addition, we retrospectively reviewed the literature on all reported cases with cryptogenic hemoptysis, obtained through PubMed and Chinese journal searches.
The intervention with embolization was successful, and no new episodes of acute hemoptysis were observed.
Angiography can be used for diagnosis of Dieulafoy's disease of the bronchus, whereas bronchoscopy biopsy should be avoided. Interventions such as embolization or bronchial coagulation play an important role in patients with coughing with massive hemoptysis.
支气管迪厄拉富瓦病是一种动脉异常疾病，其特征为黏膜动脉分支增粗，易发生致命性出血。迄今为止，该疾病在文献中鲜有报道。我们近期在2010年2月至2017年3月间遇到3例患者，每例患者的支气管均存在这种血管异常并伴有大量咯血。
本文描述支气管迪厄拉富瓦病的临床特征及治疗方法。
我们报告3例反复大量咯血的病例。对2例患者进行了支气管镜检查，其中1例发现非搏动性息肉样结节，另1例未发现。1例患者活检后发生致命性出血，无法耐受支气管动脉栓塞或开胸手术。另外2例患者的血管造影和支气管动脉栓塞成功止血。此外，我们通过检索PubMed和中国期刊，对所有已报道的不明原因咯血病例的文献进行了回顾性分析。
栓塞干预成功，未观察到新的急性咯血发作。
血管造影可用于诊断支气管迪厄拉富瓦病，而应避免支气管镜活检。栓塞或支气管凝固等干预措施在大量咯血患者中发挥着重要作用。
