Objective To investigate the causes, clinical features, therapy and treatment outcomes of recurrent hemoptysis in children and to improve the skills of pediatricians in the etiological diagnosis and treatment of recurrent hemoptysis in children. Methods The clinical, laboratory, and imaging data of 39 children with recurrent hemoptysis between January 1996 and February 2013 were collected to retrospectively analyze the age of onset, etiology, amount of hemoptysis, imaging changes, treatment methods, and follow-up outcomes. Results In the 39 children, including idiopathic pulmonary hemosiderosis (16 cases, 41%), pulmonary vascular malformation (8 cases, 21%), pulmonary arteriovenous fistula (7 cases, 18%), bronchiectasis (3 cases, 8%), pulmonary tuberculosis (2 cases, 5%), pulmonary cystic fibrosis (2 cases, 5%), and lung tumor (1 case, 3%). The contrast-enhanced lung CT scans and pulmonary and bronchial arteriography revealed varying degrees of lung imaging changes in 35 cases. Of all cases, 51% were classified as degree I, 28% as degree Ⅱ, and 21% as degree Ⅲ. All children were treated according to the etiology, with the disease controlled. During 0.5-5 years of follow-up, 3 patients with idiopathic pulmonary hemosiderosis were lost to follow-up, and the other cases did not develop hemoptysis again. Conclusions Idiopathic pulmonary hemosiderosis is the main cause of recurrent hemoptysis in children. Contrast-enhanced lung CT scans and pulmonary and bronchial arteriography are important methods for the etiological diagnosis of recurrent hemoptysis in children. Treatment methods should be selected according to the etiology.
Key words
Hemoptysis /
Idiopathic pulmonary hemosiderosis /
Etiology /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] 廖清奎. 儿科症状鉴别诊断学[M]. 北京: 人民卫生出版社, 1998, 102.
[2] 钟礼立, 黄寒, 李云, 等. 纤维支气管镜在儿童咯血诊断与 治疗中的应用[J]. 中国内镜杂志, 2009, 15(7): 759-761.
[3] 马渝燕, 焦安夏, 饶小春, 等. 咯血患儿104 例临床回顾分 析[J]. 中国实用儿科杂志, 2012, 27(7): 530-532.
[4] 肖曼和. 儿童特发性肺含铁血黄素沉着症10 例误诊分析[J]. 中国当代儿科杂志, 2001, 3(1): 69-72.
[5] 杨昆, 廖清奎, 赵亚宁. 儿童特发性肺含铁血黄素沉着症临 床及误诊分析[J]. 四川医学, 2006, 27(9): 964-965.
[6] 刘芳蕾, 陈恩国, 周畔, 等. 气管小叶毛细血管瘤二例并文 献复习[J]. 中华结核和呼吸杂志, 2010, 33(11): 849-852.
[7] Madhusudhan KS, Srivastava DN, Gamanagatti S. Multifocal epithelioid hemangioendothelioma presenting with hemoptysis[J]. Indian J Pediatr, 2010, 77(6): 699-700.
[8] Rodrigues CE, Callado MR, Nobre CA, et al. Wegener's granulomatosis: prevalence of the initial clinical manifestations—report of six cases and review of the literature[J]. Rev Bras Reumatol, 2010, 50(2): 150-164.
[9] Woo P. Theoretical and practical basis for early aggressive therapy in paediatric autoimmune disorders[J]. Curr Opin Rheumatol, 2009, 21(5): 552-557.
[10] 邱奕宁, 郝琎琎, 赵琳, 等. 肺含铁血黄素沉着症26 例的临 床特点和预后分析[J]. 临床急诊杂志, 2012, 13(6): 404-406.
[11] Vrielynck S, Mamou-Mani T, Emond S, et al. Diagnostic value of high-resolution CT in the evalutation of chronic infiltrative lung disease in children[J]. AJR Am J Roentgenol, 2008, 191(3): 914-920．
[12] 米崧, 张黎明, 毛文苹, 等. CT 肺动脉及支气管动脉联合造 影对咯血患者的诊断价值[J]. 中华结核和呼吸杂志, 2012, 35(1): 42-44.
[13] 蔡栩栩, 尚云晓. 特发性肺含铁血黄素沉着症诊断和治疗进 展[J]. 实用儿科临床杂志, 2011, 26(16): 1231-1234.
[14] 麦贤弟, 谢媛媛, 黄花荣, 等. 糖皮质激素吸入治疗特发性 肺含铁血黄素沉着症1 例及随访报告[J]. 中国当代儿科杂志, 2003, 5(6): 543-544.
[15] Chun JY, Morgan R, Belli AM. Radiological management of hemoptysis: a comprehensive review of diagnostic imaging and bronchial arterial embolization[J]. Cardiovasc Intervent Radiol, 2010, 33(2): 240-250.
[16] Shin JH, Park SJ, Ko GY, et al. Embolotherapy for pulmonary arteriovenous malformations in patients without hereditary hemorrhagic telangiectasia[J]. Korean J Radiol, 2010, 11(3): 312-319.
[17] 郭家龙, 张军, 罗卫民, 等. 典型肺动静脉瘘合并心脏形态 改变一例及文献复习[J]. 海南医学, 2012, 23(9): 56-58.
PDF(1285 KB)
