hemoptysis with chest pain
Introduction
Introduction Hemoptysis refers to the bleeding of the respiratory organs below the throat. The hemoptysis is discharged from the oral cavity by coughing action. First, the oral cavity, pharyngeal and nasal bleeding must be differentiated from the oral cavity and pharyngeal bleeding. Most of the nasal bleeding occurs from the anterior nares, and it is often easier to diagnose the hemorrhage in the anterior and posterior septum. Sometimes the amount of bleeding in the back of the nasal cavity is more, can be misdiagnosed as hemoptysis. If you use nasopharyngoscopy to see blood flowing from the posterior nostril along the pharyngeal wall, you can confirm the diagnosis. A large number of hemoptysis must be differentiated from hematemesis (upper gastrointestinal bleeding). The former often has a history of tuberculosis, bronchiectasis, lung cancer, heart disease, etc. Before the bleeding, there is cough, throat itching, chest tightness, and the blood is bright red, mixed with foam. There is no tar-like stool; the latter often has a history of peptic ulcer, liver cirrhosis, etc. Before the bleeding, there is upper abdominal discomfort, nausea and vomiting, etc. The vomiting blood is brownish black or dark red, sometimes bright red, mixed with food residue gastric juice, tar The stool can last for several days after the hematemesis stops. Hemoptysis with chest pain can be seen in lobar pneumonia, pulmonary infarction, tuberculosis, and bronchial lung cancer.
Cause
Cause
Although various methods of examination have been applied to patients with hemoptysis, 5% to 15% of patients have unclear hemoptysis, which is called occult hemoptysis. Partial occult hemoptysis may be caused by lesions such as tracheal and bronchial non-specific ulcers, varicose veins, early adenomas, bronchial calculi, and mild bronchiectasis.
1, bronchial diseases: common bronchodilation (tuberculosis or non-tuberculosis), chronic bronchitis, endobronchial tuberculosis, bronchial carcinoma (primary lung cancer). Less common are benign bronchoma, intrabronchial stones, non-specific bronchial ulcers.
2, lung disease: common pulmonary tuberculosis, pneumonia, lung abscess, etc., less common are pulmonary blood stasis, pulmonary infarction, malignant tumor metastasis, pulmonary cyst, pulmonary fungal disease, paragonimiasis. Tuberculosis is one of the most common causes of hemoptysis.
3, cardiovascular disease: more common is hemoptysis caused by mitral stenosis. Hemoptysis can also occur in certain congenital heart diseases such as atrial septal defect, patent ductus arteriosus, and other pulmonary hypertension.
4, other blood diseases: (such as thrombocytopenic purpura, leukemia, hemophilia, etc.); acute infectious diseases (such as pulmonary hemorrhagic leptospirosis, epidemic hemorrhagic fever, etc.); connective tissue disease (such as nodular Arteritis); endometriosis and the like. Breakline
Examine
an examination
Related inspection
Chest MRI Mycobacterium tuberculosis gene test (PCR) chest CT chest CT examination
Clinical manifestation
Hemopty volume
Small amount of hemoptysis: daily hemicular blood volume within 100ml;
Moderate amount of hemoptysis: daily hemoptysis 100~500ml;
A large number of hemoptysis: daily hemoptysis more than 500ml, or a hemoptysis 300~500ml, seen in tuberculosis, branch expansion and chronic lung abscess (vascular erosion and rupture).
2. Signs: The lungs should be examined in detail. When the chest X-ray examination has not been carried out, in order to clear the bleeding site as early as possible, the percussion method can be used. For example, when the hemoptysis starts, the breathing sound of one side of the lung is weakened or (and) the murmur is present, and the breathing sound of the contralateral lung field is good, often prompting. The bleeding is on this side. Physical examination can also support some specific diagnoses, such as mitral diastolic murmur is conducive to the diagnosis of rheumatic heart disease; wheezing sounds in the limited lung and bronchus, often suggesting bronchial lesions, such as lung cancer or foreign body The vascular murmur in the lung field supports arteriovenous malformation; the club finger is more common in lung cancer, bronchiectasis and lung abscess; the supraclavicular and anterior scalene lymph nodes are swollen and support metastatic cancer.
an examination
1. routine examination of hematuria, examination of blood coagulation mechanism, acid-fast bacilli in the sputum, tumor cells, lung premature eggs, common culture of sputum and fungal culture, etc., help a lot to determine the cause of hemoptysis.
2. X-ray examination: Chest X-ray should be performed for each hemoptysis. If necessary, perform posterior and lateral anterior and lateral photography, rest and CT photography.
3. Bronchoscopy.
4. Electrocardiogram.
Diagnosis
Differential diagnosis
The primary disease of hemoptysis should be identified according to the accompanying symptoms of hemoptysis:
1, with fever, can be seen in tuberculosis, pneumonia, lung abscess, pulmonary hemorrhagic leptospirosis, epidemic hemorrhagic fever, bronchial cancer.
2, with chest pain, can be seen in lobar pneumonia, pulmonary infarction, tuberculosis, bronchial cancer.
3, with cough, can be seen in bronchial cancer, mycoplasmal pneumonia.
4, with skin and mucous membrane bleeding, pay attention to leptospirosis, epidemic hemorrhagic fever, blood disease, connective tissue disease.
5, with jaundice, pay attention to leptospirosis, lobar pneumonia, pulmonary infarction and so on.
Clinical color identification
The color of hemoptysis is helpful for the diagnosis of clinical diseases. Pink foamy sputum suggests acute left heart failure (also known as pulmonary edema); bronchiectasis hemoptysis is bright red; typical lobar pneumonia hemoptysis is rust color; Thick dark red blood: The hemoptysis is not bright red when the mitral stenosis is combined with pulmonary congestion, but is generally dark red.
