Đặc điểm hình ảnh cắt lớp vi tính ngực và nội soi phế quản ở bệnh nhân ho ra máu

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Tác giả: Quang Huy Huỳnh, Vũ Diễm Hằng Trần, Hoài Nam Vũ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2024

Mô tả vật lý: tr.193

Bộ sưu tập: Metadata

ID: 442498

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Đặt vấn đề: Ho ra máu là nguyên nhân của 15.000 bệnh nhân nhập viện mỗi năm. Tại Việt Nam, số bệnh nhân ho ra máu chiếm tỷ lệ 37,5% số trường hợp nhập cấp cứu. Xquang ngực, chụp cắt lớp vi tính lồng ngực và nội soi phế quản được dùng để chẩn đoán nguyên nhân và xác định vị trí xuất huyết với những ưu nhược điểm khác nhau. Đề tài này nhằm mô tả đặc điểm tổn thương phát hiện qua cắt lớp vi tính lồng ngực có cản quang và nội soi phế quản. Đối tượng, phương pháp: Bệnh nhân được chẩn đoán là ho ra máu, khi nhập viện được tiến hành đồng thời cả chụp CLVT lồng ngực có cản quang và NSPQ. Kết quả được 2 bác sĩ Chẩn đoán hình ảnh đọc độc lập, đã có hơn 10 năm kinh nghiệm đọc các hình ảnh CLVT lồng ngực. Hai bác sĩ không biết trước kết quả NSPQ. Kết quả: Đặc điểm tổn thương qua CLVT lồng ngực có cản quang bao gồm tổn thương kính mờ và tổn thương gợi ý nguyên nhân (giãn phế quản, lao hoạt động, viêm cũ, viêm phổi, u nấm, u ác tính…). Tổn thương kính mờ (74,4%) đa số phân bố ở nhiều thùy, tổn thương gợi ý nguyên nhân cũng rất thường gặp (73,2%). Chỉ 7,1% trường hợp không có cả hai loại tổn thương đã nêu trên. Khi thực hiện NSPQ, tỷ lệ chảy máu hoạt động và máu cũ trong nghiên cứu của chúng tôi lần lượt là 41,1% và 25,6%. Trong các tổn thương khác ngoại trừ chảy máu, u sùi chiếm tỷ lệ cao (19,6%). Chỉ 6% bệnh nhân có kết quả NSPQ bình thường. Kết luận: Sự kết hợp giữa nội soi phế quản và chụp cắt lớp vi tính lồng ngực có cản quang mang lại kết quả tốt nhất trong chẩn đoán và tiếp cận ho ra máu. Abstract Background: Hemoptysis is the cause of 15,000 hospital admissions each year. In Vietnam, the number of patients coughing up blood accounts for 37.5% of emergency room admissions. Chest X-ray, chest computed tomography and bronchoscopy are used to diagnose the cause and determine the location of bleeding with different advantages and disadvantages. This study aims to describe the characteristics of lesions detected through contrast-enhanced chest computed tomography and bronchoscopy. Methods: A prospectively study was conducted on patient who was diagnosed with hemoptysis. At admission, a contrast - enhanced chest CT scan and bronchoscopy were simultaneously performed. The results were read independently by 2 radiologists who have more than 10 years of experience reading chest CT images. The two doctors did not know the bronchoscopy results in advance. Results: Characteristics of lesions through chest CT with contrast included ground glass lesions and lesions suggesting causes (bronchiectasis, active tuberculosis, old inflammation, pneumonia, mycosis, malignant tumor...). Ground glass lesions (74.4%) were mostly distributed in multiple lobes, lesions suggesting causes were also very common (73.2%). Only 7.1% of cases did not have both types of lesions mentioned above. When performing bronchoscopy, the rates of active bleeding and old bleeding in our study were 41.1% and 25.6%, respectively. In other lesions except bleeding, warts account for a high proportion (19.6%). Only 6% of patients had normal bronchoscopy results. Conclusion: The combination of bronchoscopy and chest computed tomography with contrast provides the best results in the diagnosis and approach of hemoptysis. DOI: 10.59715/pntjmp.3.1.23

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