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咯血的一个意想不到的病因:支气管静脉曲张及文献综述

An unexpected culprit of haemoptysis: Bronchial varices and review of literature.

作者信息

Bansal Avdhesh, Sharma Priya

机构信息

Department of Pulmonary, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi, India.

出版信息

Lung India. 2024 Sep 1;41(5):366-370. doi: 10.4103/lungindia.lungindia_201_24. Epub 2024 Aug 31.

DOI:10.4103/lungindia.lungindia_201_24
PMID:39215980
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11472986/
Abstract

Bronchial varices, characterized by dilated and tortuous vessels within the bronchial tree, are a rare entity often presenting as massive or recurrent haemoptysis. Multiple aetiologies have been described in the literature including congenital or acquired pulmonary vein stenosis secondary to surgical or radiofrequency ablation or other cardiac interventions. We present a case of a 60-year-old female with a history of systemic hypertension, hypothyroidism and sick sinus syndrome, who presented with intermittent episodes of dry cough and haemoptysis. A diagnostic workup revealed circumferential bronchial thickening and pulmonary vein stenosis on contrast-enhanced chest computed tomography (CT). Bronchoscopic findings confirmed the presence of bronchial varices, which was secondary to the Radiofrequency ablation she underwent 7 years ago. This case highlights the diagnostic challenge posed by bronchial varices and underscores the importance of a comprehensive approach in managing such rare presentations.

摘要

支气管静脉曲张的特征是支气管树内血管扩张和迂曲,是一种罕见的病症,常表现为大量或反复咯血。文献中描述了多种病因,包括先天性或后天性肺静脉狭窄,继发于手术、射频消融或其他心脏介入治疗。我们报告一例60岁女性,有系统性高血压、甲状腺功能减退和病态窦房结综合征病史,出现干咳和咯血的间歇性发作。诊断性检查显示,在对比增强胸部计算机断层扫描(CT)上有环形支气管增厚和肺静脉狭窄。支气管镜检查结果证实存在支气管静脉曲张,这是她7年前接受射频消融治疗的继发结果。该病例突出了支气管静脉曲张带来的诊断挑战,并强调了采用综合方法处理此类罕见病症的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fe35/11472986/a275aef8689f/LI-41-366-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fe35/11472986/8131c66e4f42/LI-41-366-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fe35/11472986/4ecbcd8e81e1/LI-41-366-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fe35/11472986/a275aef8689f/LI-41-366-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fe35/11472986/8131c66e4f42/LI-41-366-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fe35/11472986/4ecbcd8e81e1/LI-41-366-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fe35/11472986/a275aef8689f/LI-41-366-g003.jpg

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本文引用的文献

1
Unilateral pulmonary vein atresia presenting with recurrent hemoptysis and bronchial varices in an Ethiopian adolescent: a case report.单侧肺静脉闭锁导致埃塞俄比亚青少年反复咯血和支气管静脉曲张:一例报告。
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2
Bronchial varices in a child with tricuspid atresia six years post Fontan correction.在Fontan矫正术后六年的一名三尖瓣闭锁患儿中发现支气管静脉曲张。
Respirol Case Rep. 2020 Jul 16;8(7):e00620. doi: 10.1002/rcr2.620. eCollection 2020 Oct.
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Massive Pulmonary Hemorrhage from Bronchial Varix.
Case Rep Pulmonol. 2020 Apr 4;2020:9175785. doi: 10.1155/2020/9175785. eCollection 2020.
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A Case of Hemoptysis Due to Bronchial Varices Treated with Variceal Sclerotherapy.
Am J Respir Crit Care Med. 2020 Jul 1;202(1):e3-e4. doi: 10.1164/rccm.201911-2110IM.
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Haemoptysis and bronchial congestion due to pulmonary vein stenosis after maze procedure.迷宫手术后因肺静脉狭窄导致的咯血和支气管充血
Respirol Case Rep. 2019 Aug 13;7(7):e00467. doi: 10.1002/rcr2.467. eCollection 2019 Oct.
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Use of Sclerotherapy for the Treatment of Massive Hemoptysis due to a Bleeding Bronchial Varix.
Ann Am Thorac Soc. 2017 Jul;14(7):1221-1223. doi: 10.1513/AnnalsATS.201611-845CC.
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Bronchial varices in congenital unilateral pulmonary vein atresia.先天性单侧肺静脉闭锁中的支气管静脉曲张。
Am J Respir Crit Care Med. 2013 Jun 1;187(11):1267-8. doi: 10.1164/rccm.201211-1974IM.
8
A case of tracheal varices in an adolescent patient with cyanotic heart disease.一名患有发绀性心脏病的青少年患者发生气管静脉曲张。
Ann Am Thorac Soc. 2013 Feb;10(1):26-30. doi: 10.1513/AnnalsATS.201208-048BC.
9
A complex pulmonary vein varix -- diagnosis with ECG gated MDCT, MRI and invasive pulmonary angiography.一例复杂肺静脉瘤样扩张——经心电图门控多层螺旋CT、磁共振成像及有创性肺血管造影诊断
J Radiol Case Rep. 2012 Dec;6(12):9-16. doi: 10.3941/jrcr.v6i12.1017. Epub 2012 Dec 1.
10
Hemoptysis from bronchial varices associated with pulmonary vein stenosis: role of surgical repair.支气管静脉瘤伴肺静脉狭窄所致咯血:手术修复的作用。
Pediatr Pulmonol. 2013 Aug;48(8):838-40. doi: 10.1002/ppul.22659. Epub 2012 Sep 19.