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目的提高临床对少见原因引起咯血的诊疗水平。方法对4例已经明确诊断的少见原因引起咯血患者的临床资料进行分析,并结合文献复习。结果 4例咯血病因分别是肋间动脉-肺动脉瘘(intercostal-to-pulmonary arterial fistula,IPAF)、肺内错构瘤(pulmonary hamartoma,PH)、单纯性左肺动脉缺如(absence of the left pulmonary artery,ALPA)、原发性肺动脉高压(primary pulmonaryhypertension,PPH),均为临床少见病例。IPAF 首选支气管动脉造影及栓塞;肺内错构瘤为肺部良性肿瘤,结合病史和影像一般可以获得初步诊断,确诊及治疗依赖手术;ALPA 影像检查可以获得诊断,如果合并大咯血,手术治疗是最佳的临床选择;PPH 经 X 线胸片、超声心动图即可获得初步诊断,右心导管检查是确诊的可靠依据。结论咯血为呼吸系统常见症状之一,但少见原因引起的咯血容易误诊。遇到不明原因的咯血患者应详细询问病史并结合临床检查,才能获得正确的诊断及治疗。
Objective To improve clinical diagnosis and treatment of rare causes of hemoptysis. Methods The clinical data of 4 patients with hemoptysis who had been diagnosed by the rare causes were analyzed and combined with the literature review. Results Four cases of hemoptysis were intercostal-to-pulmonary arterial fistula (IPAF), pulmonary hamartoma (PH), simple absence of the left pulmonary artery , ALPA) and primary pulmonary hypertension (PPH), are all rare clinical cases. IPAF preferred bronchial artery angiography and embolization; intrapulmonary hamartoma is a benign tumor of the lung, the combination of history and imaging can generally be obtained preliminary diagnosis, diagnosis and treatment-dependent surgery; ALPA imaging diagnosis can be obtained, if combined with massive hemoptysis, surgical treatment is The best clinical choice; PPH by X-ray, echocardiography to obtain a preliminary diagnosis, right heart catheterization is a reliable basis for diagnosis. Conclusions Hemoptysis is one of the most common respiratory symptoms. However, it is easy to misdiagnose hemoptysis caused by rare causes. Patients with unidentified hemoptysis should be asked in detail about the history and combined with clinical examination, in order to obtain the correct diagnosis and treatment.