背景:支气管Dieulafoy病(BDD),一种很少报道的疾病,来自支气管粘膜下扩张或异常的动脉。BDD患者通常无症状,因此该疾病经常被误诊。然而,粘膜下动脉可能因各种原因扩张和破裂,导致反复呼吸道出血和可能危及生命的疾病。随着血管内压等可逆因素的变化,动脉可能会恢复正常,让患者恢复到无症状状态。这一现象在以往的研究中没有被提及和关注,但它可能对我们正确认识这种疾病有重要意义。
方法:一名44岁的女性因复发性恶性心律失常入院重症监护病房。在VA-体外膜氧合(ECMO)的协助下,她的生命体征和内部环境都逐渐稳定。然而,她经历了反复的呼吸道出血。在用纤维支气管镜去除血腥分泌物的同时,在患者的左主支气管壁上发现了一个充血的突出颗粒。
方法:患者被诊断为BDD,颗粒被认为是BDD的异常动脉。
方法:对于患者的病情,我们未对异常动脉实施任何针对性干预.
结果:VA-ECMO断奶后,患者的颗粒找不到,出血也消失了。她逐渐戒断机械通气,转到心内科。患者病情稳定后出院。在半年多的时间里,病人身体状况正常。
结论:异常动脉的出现和消失是BDD的一个有趣现象。由于各种原因如VA-ECMO引起的血管内压的变化可能是其主要因素。
BACKGROUND: Bronchial Dieulafoy disease (BDD), a rarely reported disease, comes from dilated or abnormal arteries under the bronchial mucosa. Patients with BDD are generally asymptomatic so this disease is frequently misdiagnosed. However, the submucosal arteries may dilate and rupture for various reasons, leading to recurrent respiratory tract bleeding and potentially life-threatening conditions. With the change of reversible factors such as intravascular pressure, the arteries may return to normal, allowing patients to recover to an asymptomatic state. This phenomenon has not been mentioned and concerned in previous studies, but it may have important implications for our correct understanding of this disease.
METHODS: A 44-year-old female was admitted to intensive care unit with recurrent malignant arrhythmias. With the assistance of VA-extracorporeal membrane oxygenation (ECMO), both her vital signs and internal environment were all gradually stabilized. However, she had been experiencing recurrent respiratory tract bleeding. While removing the bloody secretion with a fiber bronchoscopy, a congested protruding granule on the wall of the patient\'s left principal bronchus was found.
METHODS: The patient was diagnosed with BDD and the granule was thought to be an abnormal artery of BDD.
METHODS: For the patient\'s condition, we did not implement any targeted interventions with the abnormal artery.
RESULTS: After the weaning of VA-ECMO, the patient\'s granule could not be found and the bleeding had also disappeared. She gradually weaned off the mechanical ventilation and was transferred to the Department of Cardiology. Then the patient was discharged after her condition stabilized. In more than half a year, the patient is in a normal physical condition.
CONCLUSIONS: The appearance and disappearance of abnormal artery is an interesting phenomena of BDD. The change of intravascular pressure due to various causes such as VA-ECMO may be the primary factor of it.