Oudah Marwa, Sandhu Hargeet, Sissoho Fattoumata, Sabath Bruce
Department of Medicine, Greater Baltimore Medical Center, Baltimore, MD, USA.
Division of Pulmonary and Critical Care Medicine, Greater Baltimore Medical Center, Baltimore, MD, USA.
J Community Hosp Intern Med Perspect. 2019 Sep 5;9(4):365-366. doi: 10.1080/20009666.2019.1635839. eCollection 2019.
A 59-year old woman presented with hemoptysis of thick blood clots and fever of two days duration. Her medical history included sarcoidosis for which she was on chronic steroids. Computed tomography imaging revealed stage IV sarcoidosis with diffuse cystic and fibrotic changes bilaterally, worse in the right lung. She underwent bronchoscopy to attempt to localize a source but none was clearly found; no biopsies were performed. Immediately post-procedure she developed massive hemoptysis with hypoxia leading to cardiopulmonary arrest. She was intubated and stabilized with the spontaneous cessation of her bleeding. Immediate angiography revealed no active extravasation, but localized embolization was performed on the right main and right accessory bronchial arteries because these appeared hypertrophied and irregular. Two days later, she again developed spontaneous massive hemoptysis leading to cardiopulmonary arrest. Manual ventilation through the endotracheal tube became impossible. Immediate bronchoscopy identified a blood clot extending from the main carina into the left main stem bronchus. This was removed with a cryoprobe and ventilation could then be achieved easily. Examination of the blood clot demonstrated it to be a cast of the proximal left bronchial tree. Despite the return of spontaneous circulation via resuscitative efforts, the patient developed acute respiratory distress syndrome and later expired.
一名59岁女性出现咳出浓稠血块和发热症状，持续两天。她的病史包括结节病，一直在接受慢性类固醇治疗。计算机断层扫描成像显示为IV期结节病，双侧弥漫性囊性和纤维化改变，右肺更严重。她接受了支气管镜检查以试图确定出血源，但未明确发现；未进行活检。术后立即出现大量咯血伴缺氧，导致心肺骤停。她被插管并在出血自行停止后病情稳定。立即进行的血管造影显示无活动性外渗，但对右主支气管和右副支气管动脉进行了局部栓塞，因为这些动脉显得肥大且不规则。两天后，她再次出现自发性大量咯血，导致心肺骤停。通过气管内导管进行手动通气变得不可能。立即进行的支气管镜检查发现一个血凝块从主隆突延伸至左主支气管。用冷冻探头将其清除，然后可以轻松实现通气。对血凝块的检查表明它是左主支气管近端树的铸型。尽管通过复苏努力恢复了自主循环，但患者仍发展为急性呼吸窘迫综合征，随后死亡。
