bloody sputum
Introduction
Introduction Most respiratory diseases have cough and cough symptoms. It can be a grayish white mucus or a yellow-green purulent. Sometimes the coughed sputum has bright red blood, which is called hemoptysis. Medically, hemorrhage is caused by hemorrhage of the trachea, bronchus or lung tissue below the larynx and excreted by cough.
Cause
Cause
Chinese medicine believes that because of kidney deficiency, yin and blood, blood, or heart, through the fire and blood.
The main mechanisms of hemoptysis are as follows:
1. Increased vascular permeability Due to pulmonary infection, poisoning or vascular embolism, pathogens and other Xie products may directly damage microvessels or increase the microvascular wall through the action of vasoactive substances. The interstitial cell gap enters the alveoli and produces a small amount of hemoptysis.
2, vascular wall erosion, rupture of the lungs, chronic damage to the elastic fibers of the blood vessel wall, local formation of small arterial hemangioma in severe cough or movement of the hemangioma rupture and massive bleeding, often causing asphyxia, sudden death, such hemangioma is more common in Cavity tuberculosis.
3, pulmonary intravascular pressure increased rheumatic heart stenosis with the same valve stenosis, pulmonary hypertension, high blood graves, heart disease and other conditions, increased pulmonary blood pressure, can cause blood extravasation or small blood vessels rupture and cause hemoptysis.
4, stop, coagulation dysfunction is common in thrombocytopenic purpura and other blood diseases, closed by factors such as clotting factor defects or coagulation process disorders and vasoconstriction, hemoptysis may also occur on the basis of systemic bleeding tendency.
5, mechanical injury trauma or tuberculosis calcification, bronchial stones on the mechanical damage caused by hemoptysis.
Examine
an examination
Related inspection
Routine examination of sputum culture sputum enzyme-linked immunosorbent assay
First, medical history
Asking for bleeding for the first time or multiple times is a number of times, which is different from the past. Young adults with cough and hemoptysis with low fever should consider tuberculosis. People of middle age or above, especially male smokers, should pay attention to the possibility of lung cancer; they must carefully inquire and observe the color of hemoptysis, with or without sputum, and ask about the history of smoking in the history of tuberculosis, history of menstruation, occupation Sexual dust contact history of raw crabs, history and so on. Hemoptysis with chest pain is more common in pneumococcal pneumonia. The hemoptysis with cough is more common in bronchial lung cancer, and the ktk of mycoplasma pneumonia is seen in the lung abscess. A large number of hemoptysis are more common in cavitary tuberculosis, bronchodilator aneurysm rupture.
Second, physical examination
Patients with hemoptysis should be carefully examined repeatedly. Some chronic heart and lung diseases can be accompanied by clubbing (toe). Progressive tuberculosis and lung cancer patients often have significant weight loss. Some blood diseases have systemic hemorrhagic tendency.
Third, laboratory inspection
The sputum examination helps to discover Mycobacterium tuberculosis fungi, bacteria, cancer cell parasite eggs, heart failure cells, and the like. Hemorrhagic time clotting time, prothrombin time platelet count and other tests help to diagnose bleeding disorders. Red blood cell count and protoerythrin determination help to infer the degree of bleeding, and eosinophilia suggests the possibility of parasitic diseases.
Fourth, equipment inspection
1, X-ray examination: patients with hemoptysis should be X-ray examination, chest fluoroscopy, chest radiographs, and bronchography can be used to assist diagnosis if necessary.
2, CT examination: help to find small bleeding lesions.
3, bronchoscopy: patients with unexplained hemoptysis or bronchial obstruction of atelectasis should consider bronchoscopy, such as tumors, tuberculosis foreign bodies, etc., while taking direct biopsy pathological examination or foreign body removal, bleeding and sputum aspiration Wait.
4, radioactive radionuclide gallium examination: help the differential diagnosis of lung cancer and other lung masses.
The blood discharged through the oral cavity is not all hemoptysis and hemoptysis should be identified with oral, nasal bleeding or hematemesis of the upper digestive tract. The oral blood is often mixed with saliva, and the mouth can be found in the mouth. The differential diagnosis is generally not difficult when the nose is bleeding. It is not difficult to diagnose the nostrils with the nostrils. However, the blood flows down the pharyngeal wall from the posterior nostrils. After inhaling the respiratory tract and then coughing out, it is easily misdiagnosed as hemoptysis. The lesions and bleeding points must be carefully examined in the nasal cavity. Stop digestive tract hematemesis and hemoptysis sometimes identify more difficult to vomiting before vomiting and upper abdominal discomfort, vomiting can be mixed with food, often vomiting after hematemesis patients often have stomach problems, liver history.
Diagnosis
Differential diagnosis
Hemoptysis is a common disease in which clinical common symptoms should further cause hemoptysis. Many diseases can cause hemoptysis. The following diseases are mainly diagnosed and diagnosed:
First, respiratory diseases
1. Tuberculosis
Hemoptysis is a common symptom of tuberculosis patients. About 50% of patients have hemoptysis of varying degrees. Many patients have cubits of TB due to hemoptysis. The amount of hemoptysis varies, and the few are only bloody and bloody. One hemoptysis can be more than 500ml tuberculosis hemoptysis color is bright red.
Second
Hemoptysis is a common symptom of bronchiectasis, and the literature reports that about 90% of patients have varying degrees of hemoptysis. A small number of people with more than 500ml each time, is bright red.
3, lung cancer
About 60% of primary lung cancers have hemoptysis symptoms, mostly persistent or sputum sputum with blood or small amount of hemoptysis, and blood stasis is rare. This disease is more common in elderly patients, and blood stasis is the first symptom in about 20% of patients.
4, lung abscess
Sudden onset of illness, high fever, cough and chest pain, spit a large amount of pus sputum or pus and blood stasis, often complications of pneumonia and staphylococcal septicemia, about 50% of patients have hemoptysis symptoms, hemoptysis is not large. When the course of disease is coughed for about 2 weeks, the patient's body temperature is also reduced, the lesions can be gradually absorbed, and the condition is improved. The recent recovery and recovery can form chronic lung abscess.
5, chronic bronchitis
Chronic bronchitis also has hemoptysis, usually a small amount or blood in the sputum, generally caused by bronchial mucosal congestion, no need to treat within 3 to 4 days, but easy to relapse signs, X-ray and sputum examination Often no characteristic changes, patients with chronic bronchitis should be careful to find other causes, especially bronchial cancer, in order to avoid delay in diagnosis.
6, pneumonia
Most patients with acute pneumonia have a rapid onset of symptoms, such as chills and high fever, cough and chest pain, hemoptysis, and hemoptysis. The reason is that the lung parenchyma is in a highly hyperemic state with increased permeability of small blood vessels and rupture and hemoptysis.
7, pulmonary fungal disease
Including Candida albicans, Pneumocystis and new cryptococcosis, usually with fever, cough, hemoptysis or pus and blood stasis are more common in the elderly, children or frail malnutrition patients, X-ray and purulent pneumonia and tuberculosis Patients with mixed X-rays are easily confused with suppurative pneumonia and tuberculosis, and straight bacteria or seropositive reactions can be confirmed in the sputum.
8, pulmonary amoebiasis
One of the complications of hepatic amoebiasis can also be from intestinal lesions. Usually there is fever, cough, chest pain and easy to be confused with chronic lung abscess, tuberculosis. The typical sputum is brown and has a scent of odor. X-ray examination shows flaky inflammation or hollow shadow in the lungs, mostly in the right lower lung. You can find the amoebic trophozoites.
9, paragonimiasis
The disease has strict regional characteristics and is popular in Zhejiang, Fujian and Sichuan. All patients had eaten unripe stone crabs or sputum in the ward. The main clinical symptoms are cough, sputum, hemoptysis, chest pain, typical sputum rust or brownish yellow. Although the patient has long-term repeated hemoptysis, the general condition is not obvious, the blood eosinophils increase, X-ray can sometimes see infiltrating cystic shadow or pleural effusion pleural thickening, etc. Or find the paragonimiasis eggs in the sputum to confirm the diagnosis.
10, pulmonary hydatid disease
It is caused by the mites and mistletoe in the human lung. It can be asymptomatic in the early stage. When the cyst is enlarged and infected, there will be symptoms such as cough, cough, hemoptysis and chest pain. X-ray shows that the lung is round oval, slightly leafy. Shaped shadows, the air enters the cyst after the rupture, the top is half-moon shaped. The disease is prevalent in the northwest and Inner Mongolia region of China, and the intradermal test and complement fixation test are important for diagnosis.
Second, cardiovascular disease
1, rheumatic heart disease mitral stenosis, because of rheumatic heart disease mitral stenosis caused by left atrial failure, pulmonary vein and capillary pressure increased significantly pulmonary congestion, bronchial adhesion and capillary rupture caused by hemoptysis, mostly in the light or blood A small amount of hemoptysis left heart failure with pulmonary edema often coughs up a pink foamy sputum. According to the history of heart disease, the cardiac auscultation of the apical area of the diastolic murmur X-ray showed left atrial enlargement, the electrocardiogram showed a left ventricular enlargement of the "mitral valve P wave" and right ventricular hypertrophy, echocardiography showed a "city-like" pattern.
2, pulmonary embolism
Pulmonary embolism is caused by a blocked blood clot in the pulmonary artery. Clinical manifestations of patients with mental stress, chest pain, chest tightness, cough, hemoptysis, cold limbs, sweating, etc. Physical examination is difficult to breathe, pale, irritability, convulsions or fever, weak pulse, heart rate increased in the heart area, There are signs of acute right ventricular dysfunction such as wet rales in the lungs, jugular vein engorgement and hepatomegaly. X-ray examination of pulmonary embolism can cause signs of pulmonary hypertension, multiple small pulmonary embolism is a bronchial pneumonia-like diffuse infiltration shadow, and larger embolism occurs with a wedge-shaped shadow of pulmonary infarction. Pulmonary angiography can show that the blood vessels with a diameter of 0.5 mm or more can directly see the location and extent of the embolization. Also preparing for the surgical treatment of radionuclide scans is helpful for diagnosis.
3, pulmonary arteriovenous fistula
Congenital vascular malformation in the lungs, mostly in the young age, more men often have difficulty breathing, palpitations, approval of hemoptysis, chest pain, cyanosis, etc., due to long-term symptoms of patients with anemia symptoms.
