Middleton J R, Sen P, Lange M, Salaki J, Kapila R, Louria D B
Chest. 1977 Nov;72(5):601-4. doi: 10.1378/chest.72.5.601.
Massive hemoptysis in patients with tuberculosis is reported infrequently and then virtually always in association with cavitary disease or aspergilloma. In contrast, we describe herein five cases characterized by hemoptysis on admission, bilateral pulmonary disease, samples of sputum positive for acid-fast bacilli by Ziehl-Neelsen stain, and no obvious cavitary disease. In each, hemoptysis subsided and then suddenly recurred in prodigious amounts, leading to death, probably from asyphyxiation. In patients hospitalized with tuberculous hemoptysis of any amount, with or without an obvious cavity, aggressive diagnostic evaluation, including bronchoscopic examination, may define the site of bleeding, thus permitting rapid surgical intervention if the hemoptysis increases.
肺结核患者出现大量咯血的报道并不常见，且几乎总是与空洞性病变或曲菌球有关。相比之下，我们在此描述了5例患者，其特点是入院时咯血、双侧肺部疾病、痰涂片经齐-尼氏染色抗酸杆菌阳性，且无明显空洞性病变。每例患者的咯血均先缓解，随后突然大量复发，最终可能因窒息死亡。对于因结核咯血住院的患者，无论咯血量多少，无论有无明显空洞，积极的诊断评估，包括支气管镜检查，都可能明确出血部位，从而在咯血增加时能够迅速进行手术干预。
