背景:肺动脉瘤占胸腔动脉瘤的1%。先天性心脏缺陷是大多数(>50%)病例的原因,然而,肺动脉瘤是一种罕见的肺结核后遗症,据报道约有5%的慢性空洞性结核患者在尸检中出现。这种潜在致命疾病的自然史仍然知之甚少,最佳管理指南也存在争议。
方法:一名24岁的男子,一名非洲裔护理专业的学生,从一个有4周反复发作的呼吸困难史的国家地区医院转诊给我们,在完成6个月的抗结核药物疗程后3周,意识到心跳和咳血。体格检查显示结膜和手掌苍白,但没有结缔组织疾病的柱头,系统性血管炎或先天性心脏病。对心血管系统的检查显示,第二心音(S2)加重,肺动脉瓣和三尖瓣区域分别出现早期舒张(1/6级)和全收缩(2/6级)杂音。血液检查显示缺铁性贫血,出血时间延长,和轻度低钠血症.胸部X光片显示双侧卵球形的肺门周围混浊,而计算机断层扫描显示双侧多发性肺动脉假性动脉瘤,周围血肿以及邻近的囊性改变。合并,和树在芽中的外观。我们的患者拒绝接受手术,住院9天后死于动脉瘤破裂。
结论:即使在抗结核疗程结束后,肺结核患者中仍存在顽固性咯血,应增加对肺动脉瘤的怀疑指数。此外,尽管它很稀有,肺动脉瘤的早期识别和及时的手术干预对于降低发病率和预防归因死亡率至关重要。
BACKGROUND: Pulmonary artery aneurysms constitute <1% of aneurysms occurring in the thoracic cavity. Congenital cardiac defects are responsible for the majority (>50%) of cases, however, pulmonary artery aneurysm is a rare sequelae of pulmonary tuberculosis reported in about 5% of patients with chronic cavitary tuberculosis on autopsy. The natural history of this potentially fatal condition remains poorly understood and guidelines for optimal management are controversial.
METHODS: A 24-year-old man, a nursing student of African descent, was referred to us from an up-country regional hospital with a 4-week history of recurrent episodes of breathlessness, awareness of heartbeats and coughing blood 3 weeks after completing a 6-month course of anti-tuberculosis drugs. A physical examination revealed conjuctival and palmar pallor but there were no stigmata of connective tissue disorders, systemic vasculitides or congenital heart disease. An examination of the cardiovascular system revealed accentuated second heart sound (S2) with early diastolic (grade 1/6) and holosystolic (grade 2/6) murmurs at the pulmonic and tricuspid areas respectively. Blood tests showed iron deficiency anemia, prolonged bleeding time, and mild hyponatremia. A chest radiograph revealed bilateral ovoid-shaped perihilar opacities while a computed tomography scan showed bilateral multiple pulmonary artery pseudoaneurysms with surrounding hematoma together with adjacent cystic changes, consolidations, and tree-in-bud appearance. Our patient refused to undergo surgery and died of aneurismal rupture after 9 days of hospitalization.
CONCLUSIONS: The presence of intractable hemoptysis among patients with tuberculosis even after completion of anti-tuberculosis course should raise an index of suspicion for pulmonary artery aneurysm. Furthermore, despite of its rarity, early recognition and timely surgical intervention of pulmonary artery aneurysm is crucial to reducing morbidity and preventing the attributed mortality.