hemoptysis
Introduction
Introduction Tracheal, bronchial and pulmonary tissue hemorrhage, called hemoptysis through the oral cavity, the amount of hemoptysis varies depending on the cause or nature of the lesion. When a large amount of hemoptysis occurs, the blood flows from the mouth and nose, which can often block the respiratory tract, causing suffocation or severe blood loss to endanger life. A small amount of hemoptysis is sometimes neglected only with blood in the sputum. The amount of hemoptysis is not necessarily exactly the same as the severity of the disease. A small amount of hemoptysis, especially the continuous blood in the sputum, may be a clinical manifestation of lung cancer. Therefore, not only a large number of hemoptysis should be taken to stop bleeding and rescue, but also a small amount of hemoptysis is identified and properly handled.
Cause
Cause
There are many diseases that cause hemoptysis, mainly respiratory diseases.
1, respiratory diseases: tuberculosis, bronchiectasis, lung cancer, lung abscess, bronchitis, pneumonia, pulmonary fungal disease, lung amebiasis, paragonimiasis, bronchial stones, pneumoconiosis, malignant tumor lung metastasis, benign bronchial tumors.
2, cardiovascular disease: rheumatic heart disease, mitral stenosis, pulmonary hypertension, pulmonary congestion, pulmonary arteriovenous fistula and so on.
3, systemic diseases and other causes: thrombocytopenic purpura, leukemia, hemophilia, aplastic anemia, disseminated intravascular coagulation, pulmonary hemorrhagic leptospirosis, epidemic hemorrhagic fever, pulmonary plague, chronic kidney Failure, uremia, Behcet's disease, chest trauma, pulmonary hemorrhage, nephritis syndrome, alternative menstruation, oxygen poisoning and connective tissue disease.
Examine
an examination
Related inspection
Mycobacterium tuberculosis genetic test (PCR) bronchography chest radiograph sputum microscopy sputum cytology
1. Medical history inquiry
The bleeding is first or multiple times. If it is multiple times, it is different from the past. Young adults with cough and hemoptysis with low fever should consider tuberculosis. People over the middle age, especially male smokers, should pay attention to the possibility of lung cancer; they should carefully inquire and observe the color of hemoptysis, with or without sputum, and should pay attention to the history of TB contact when inquiring about personal history, the history of smoking for many years, the history of menstruation, History of occupational dust exposure, raw crabs, history, etc.
Hemoptysis with chest pain is more common in pulmonary infarction, pneumococcal pneumonia; hemoptysis with cough is more common in bronchial lung cancer, blood stasis is seen in lung abscess; a large number of hemoptysis are more common in cavitary tuberculosis, bronchodilator aneurysm rupture. Domestic literature reports that no jaundice-type leptospirosis also causes large hemoptysis that causes disease.
2. Physical examination
Patients with hemoptysis should be carefully examined repeatedly. Some chronic heart and lung diseases can be associated with clubbing (toe), and patients with progressive tuberculosis and lung cancer often have significant weight loss. Some blood diseases have a generalized hemorrhagic tendency.
3. Laboratory inspection
examination can help find tubercle bacilli, fungi, bacteria, cancer cell parasite eggs, heart failure cells, etc.; bleeding time, clotting time, prothrombin time, platelet count and other tests help to diagnose bleeding disorders; red blood cell count and Protoerythrin assays help to infer the extent of bleeding, and eosinophilia suggests the possibility of parasitic diseases.
4. Device inspection
(1) X-ray examination: patients with hemoptysis should be X-ray examination, chest fluoroscopy, chest radiograph, and bronchography to assist diagnosis if necessary.
(2) CT examination: help to find small bleeding lesions.
(3) bronchoscopy: patients with unexplained hemoptysis or bronchial obstruction, atelectasis should consider bronchoscopy, such as tumors, tuberculosis foreign bodies, etc., and take biopsy pathological examination.
(4) Radionuclide gallium examination: help differential diagnosis of lung cancer and other lung masses.
Diagnosis
Differential diagnosis
Hematemesis refers to the patient's vomiting of blood, due to acute bleeding of the upper digestive tract (the esophagus, stomach, duodenum, jejunum, pancreas, biliary tract after gastrojejunostomy). But it can also be seen in certain systemic diseases.
Hemoptysis with fever: can be seen in tuberculosis, pneumonia, pulmonary hemorrhagic leptospirosis, epidemic hemorrhagic fever, bronchial lung cancer.
Hemoptysis with chest pain: can be seen in lobar pneumonia, pulmonary infarction, tuberculosis, bronchial lung cancer and so on.
Pus and blood stasis: can be seen in lung abscess, hollow tuberculosis, bronchiectasis and so on. Bronchiectasis also has repeated hemoptysis without cough. This type is called dry bronchiectasis.
Hemoptysis with cough: can be seen in bronchial lung cancer, mycoplasma pneumonia and so on.
Hemoptysis accompanied by bleeding of skin and mucous membranes: attention should be paid to epidemic hemorrhagic fever and blood diseases.
Hemoptysis with jaundice: attention should be paid to pulmonary infarction and leptospirosis.
