关键词: 咯血, 放射学,介入性, 栓塞,治疗性, 肺动脉, 动脉瘤,假性

Abstract:

Objective To summarize and analyze the clinical characteristics of pulmonary tuberculosis-associated pulmonary artery pseudoaneurysms (PAP) with massive hemoptysis in the treatment of arterial embolization intervention. Methods The clinical manifestations, treatment and prognosis of 3 patients with PAP complicated with pulmonary tuberculosis and massive hemoptysis who underwent interventional embolization in Nanjing Second Hospital were reported. PubMed database was searched with key words of “pulmonary tuberculosis” and “pulmonary artery pseudoaneurysms” or “Rasmussen’s aneurym” from January 2011 to December 2020. Reviews, repeated publications and articles with incomplete data were excluded, and researches with complete clinical data of patients with tuberculosis complicated with PAP were included. The clinical features, imaging manifestations, PAP typing, methods of diagnosis and treatment, and prognosis of the patients were collected to review the literature. Results Three cases were diagnosed with pulmonary tuberculosis complicated with massive hemoptysis. Radiology suggested cavity lesion of pulmonary tuberculosis, and chest CT angiography (CTA) and pulmonary angiography showed that PAP were secondary to pulmonary artery vessels on the pulmonary cavity wall of tuberculosis. Case 1, male, 24 years old, with blood in sputum for 7 days and aggravation for 3 days (hemoptysis volume >500 ml/d, unconscious) as the main manifestations. The patient had massive hemoptysis again after bronchial artery embolization and hemoptysis was stopped after embolization of left internal thoracic artery, left lateral thoracic artery and left pulmonary artery. Case 2, female, 65 years old, with hemoptysis for 5 days (100 ml/time, twice/day) and chest tipiness as the main presentation. Massive hemoptysis was relapsed after bronchial artery embolization and was stopped until right pulmonary artery embolization surgery. Case 3, male, 58 years old, presented with cough, chest tiresomy and night sweats for 4 months and hemoptysis for 3 days (300 ml). Hemoptysis still occurred after bilateral bronchial artery embolization, and was stopped after embolization of left and right bronchial arteries and right upper pulmonary artery. Through PubMed database searching, a total of 21 literatures were obtained, of which 42 patients with tuberculosis complicated with PAP. A total of 45 patients were included with the 3 patients in this paper, including 36 males and 9 females, with a median age of 52.0 (35.0,63.0) years. CTA was performed in all patients, and the detection rate of PAP was 100.0%. Pulmonary arteriography was performed in 41 cases and the detection rate of PAP was 75.6% (31/41). Forty-one patients received vascular interventional therapy, including 26 cases of pulmonary artery embolization, 7 cases of bronchial artery embolization, 8 cases of bronchial artery embolization and pulmonary artery embolization. Forty cases were of effective hemostasis after surgery and 1 patient died of asphyxia due to massive hemoptysis. Forty cases were followed up after surgery, of which 2 patients relapsed and were cured by surgical resection and bronchial artery embolization. Conclusion PAP is one of the main causes of massive hemoptysis in pulmonary tuberculosis, and pulmonary vascular interventional embolization is still the preferred intervention for PAP complicated with massive hemoptysis. When bronchial artery embolization is not effective or hemoptysis recedes recently, chest CTA examination should be performed in time to rule out the possibility of PAP.

Key words: Hemoptysis, Radiology,interventional, Embolization,therapeutic, Pulmonary artery, Aneurysm,false