Massive Hemoptysis Due to an Anomalous Origin of the Right Pulmonary Artery from the Ascending Aorta-A Case Report

右肺動脈起源異常引起之大量咳血－病例報告

張人尹(Renin Chang) ； 許健威(Chien-Wei Hsu) ； 林志洵(Chih-Hsun Lin) ； 康沛倫(Pei-Loon Kang) ； 林少琳(Shao-Lin Lin) ； 陶宏洋(Hong-Yang Tao)

《胸腔醫學》 21卷2期 (2006/04) Pp. 168-174

https://doi.org/10.29806/TM.200604.0005

摘要

大量咳血是所有肺部急症中最可怕的一項且可以源自於多種原因。死亡率主要和潛在病因及咳血的程度有關。大量咳血具有生命危險，所以我們需要立即對病人施予搶救，保護呼吸道及嘗試治療潛在病因。很多因素可以引發大量咳血如支氣管擴張症、肺結核、肺膿瘍等慢性發炎及肺癌。血管方面的疾病如肺栓塞、肺部靜脈廔管及肺部微血管擴張症等亦會引發大量咳血。左側或右側肺動脈異常起源自上升主動脈，是少見的先天性異常；如果沒有早期接受手術通常會致命。這種先天性異常在今日已可在產前檢查發現。我們報告一位23歲女性，其右肺動脈異常起源自上升主動脈，以產後大量咳血合併呼吸衰竭做為表現。為了確立大量咳血的原因，吾人必須進行仔細的病始詢問，身體檢查，同時合併考量胸部素片，甚至電腦斷層掃瞄，支氣管鏡及血管攝影的結果，以避免誤診的情形。

關鍵字

右肺動脈起源異常 ； 咳血

並列摘要

Massive hemoptysis is 1 of the most dreaded of all respiratory emergencies, and can have a variety of underlying causes. The associated mortality rate depends mainly on the underlying etiology and the magnitude of bleeding. The unpredictable and potentially lethal course of massive hemoptysis requires prompt resuscitation, airway protection, and correction of the underlying causes. Many of the etiologies, such as chronic inflammatory conditions (including bronchiectasis, tuberculosis, and lung abscess) and lung malignancies, have been surveyed. Vascular disorders such as pulmonary emboli, arteriovenous malformations, and bronchial telangiectasis also play a role. A pulmonary artery originating from the ascending aorta is a rare (less than 1% of all congenital cardiopathies) and frequently fatal malformation, if early surgical repair is not performed. Herein, we report a 23-year-old female with an anomalous origin of the right pulmonary artery from the ascending aorta demonstrated by a computerized tomography scan of the chest, who presented massive hemoptysis, progressive dyspnea, and respiratory failure 3 days after Caesarean section.

並列關鍵字

anomalous origin of the right pulmonary artery ； hemoptysis