Zhang Jiyan,Liu Teng,Xiao Zhenghui,et al.Clinical analysis and interventional assessment of bronchial pulmonary artery fistula in children: a report of 20 cases[J].Journal of Clinical Pediatric Surgery,,():1077-1081.[doi:10.3760/cma.j.cn101785-202403024-014]
Clinical analysis and interventional assessment of bronchial pulmonary artery fistula in children: a report of 20 cases
- Keywords:
- Bronchial Arteries; Hemoptysis; Interventional; Child
- Abstract:
- Objective To summarize the clinical characteristics of bronchial pulmonary artery fistula (BPAF) and evaluate the efficacy of interventional closure. Methods For this retrospective case study,20 children were diagnosed with bronchial pulmonary artery fistula at Hunan Children’s Hospital from January 2016 to August 2023.Clinical symptoms and enhanced chest computed tomography (CT) findings were recorded.Efficacy and postoperative recurrence were evaluated. Results The symptoms of hemoptysis occurred (n=17),including mild hemoptysis (n=4),moderate hemoptysis (n=5) and massive hemoptysis (n=8).Among 3 cases of non-hemoptysis,there were hematemesis (n=1),dyspnea (n=1) and Kaposi type hemangioma with "chest wall mass" (n=1).Eleven cases had varying degrees of anemia,including mild anemia (n=3),moderate anemia (n=7) and severe anemia (n=1).Enhanced chest CT revealed thickened and tortuous bronchial arteries (n=5).Digital subtraction angiography (DSA) was performed for confirming the diagnosis of right bronchial arterio-pulmonary fistula (n=19) and left bronchial arterio-pulmonary fistula (n=1).Hemorrhagic lesions were located in right upper lobe (n=1),right middle lobe (n=4) and right lower lobe (n=7),mixed right middle/lower lobe (n=2),left lower lobe (n=1) and bilateral lungs (n=2).Sixteen cases received initial interventions.During a follow-up period of 1 to 4 years,there was no recurrence.The outcomes were satisfactory; Four cases recurred after initial interventions,3 cases relapsed once and 1 case relapsing 5 times was treated thrice.The last operation was 42 months ago.There was no recurrence. Conclusions Hemoptysis is a major clinical manifestation of BPAF.Enhanced chest CT is conducive to making a definite diagnosis and DSA is a gold standard of diagnosis.Interventional therapy is both safe and effective and it has a definite efficacy with a certain recurrence rate.
References:
[1] Nugent Z,Oliveira V,Maclusky I,et al.Bronchial artery-pulmonary artery malformation as a cause of cryptogenic hemoptysis[J].Pediatr Pulmonol,2013,48(9):930-933.DOI:10.1002/ppul.22689.
[2] 吕铁伟,况虹宇,易岂建,等.儿童血管相关性咯血的规范诊断与治疗[J].中华实用儿科临床杂志,2018,33(13):979-982.DOI:10.3760/cma.j.issn.2095-428X.2018.13.005. Lyu TW,Kuang HY,Yi QJ,et al.Standardized diagnosis and treatment of hemoptysis correlated with blood vessels in children[J].Chin J Appl Clin Pediatr,2018,33(13):979-982.DOI:10.3760/cma.j.issn.2095-428X.2018.13.005.
[3] Dong HQ,Dong LL,Yu YP,et al.Cryptogenic massive hemoptysis caused by bronchial artery-pulmonary artery fistula in a 12-year-old boy:a case report and literature review[J].Pediatr Pulmonol,2022,57(5):1202-1208.DOI:10.1002/ppul.25872.
[4] Cordovilla R,Bollo de Miguel E,Nu?ez Ares A,et al.Diagnosis and treatment of hemoptysis[J].Arch Bronconeumol,2016,52(7):368-377.DOI:10.1016/j.arbres.2015.12.002.
[5] Yang J,Liu FQ,Liang Y,et al.Massive hemoptysis in children[J].Can Respir J,2020,2020:6414719.DOI:10.1155/2020/6414719.
[6] Moynihan KM,Ge S,Sleeper LA,et al.Life-threatening hemoptysis in a pediatric referral center[J].Crit Care Med,2021,49(3):e291-e303.DOI:10.1097/CCM.0000000000004822.
[7] Michimoto K,Takenaga S,Higuchi T,et al.Direct puncture and embolization of a congenital bronchial artery to a pulmonary artery fistula[J].J Vasc Interv Radiol,2020,31(10):1610-1611.DOI:10.1016/j.jvir.2020.05.017.
[8] 刘晖,姜鹃.儿童先天性支气管动脉-肺动脉瘘的漏诊分析[J].心肺血管病杂志,2014,33(4):483-485.DOI:10.3969/j.issn.1007-5062.2014.04.005. Liu H,Jiang J.Congenital bronchial artery-pulmonary artery fistula in children:missed diagnosis and treatment[J].J Cardiovasc Pulm Dis,2014,33(4):483-485.DOI:10.3969/j.issn.1007-5062.2014.04.005.
[9] 魏梦月,李惠民,刘素琴.儿童特发性肺含铁血黄素沉着症的诊治进展[J].药学与临床研究,2023,31(4):347-351.DOI:10.13664/j.cnki.pcr.2023.04.001. Wei MY,Li HM,Liu SQ.Recent advances in diagnosis and treatment of idiopathic pulmonary hemosiderosis in children[J].Pharm Clin Res,2023,31(4):347-351.DOI:10.13664/j.cnki.pcr.2023.04.001.
[10] 中华医学会儿科学分会呼吸学组,《中华实用儿科临床杂志》编辑委员会.儿童咯血诊断与治疗专家共识[J].中华实用儿科临床杂志,2016,31(20):1525-1530.DOI:10.3760/cma.j.issn.2095-428X.2016.20.002. Branch of Respiratory Medicine,Chinese Pediatric Society,Chinese Medical Association; Editorial Board,Chinese Journal of Applied Clinical Pediatrics:Expert Consensus on Diagnosing and Treating Hemoptysis in Children[J].Chin J Appl Clin Pediatr,2016,31(20):1525-1530.DOI:10.3760/cma.j.issn.2095-428X.2016.20.002.
[11] Qu HX,Wang MQ,Wang ZJ,et al.Diagnostic value of dual-input computed tomography perfusion on detecting bronchial-pulmonary artery fistula in tuberculosis patients with massive hemoptysis[J].Acad Radiol,2018,25(8):1018-1024.DOI:10.1016/j.acra.2017.12.013.
[12] 傅萍萍,王镇章,徐浩力,等.改良式CT血管成像检测支气管动脉-肺动脉瘘价值分析[J].中华医学杂志,2020,100(1):47-50.DOI:10.3760/cma.j.issn.0376-2491.2020.01.011. Fu PP,Wang ZZ,Xu HL,et al.A clinical performance study of modified CT angiography in detecting bronchial artery-pulmonary artery fistula[J].Natl Med J China,2020,100(1):47-50.DOI:10.3760/cma.j.issn.0376-2491.2020.01.011.
[13] Mondoni M,Carlucci P,Job S,et al.Observational,multicentre study on the epidemiology of haemoptysis[J].Eur Respir J,2018,51(1):1701813.DOI:10.1183/13993003.01813-2017.
[14] 朱巧洪,孙翀鹏,林翰菲,等.支气管动脉-肺动脉瘘的多层螺旋CT血管成像表现[J].中华放射学杂志,2012,46(8):750-752.DOI:10.3760/cma.j.issn.1005-1201.2012.08.020. Zhu QH,Sun CP,Lin HF,et al.Multi slice spiral CT angiography of bronchial artery pulmonary artery fistula[J].Chin J Radiol,2012,46(8):750-752.DOI:10.3760/cma.j.issn.1005-1201.2012.08.020.
[15] Sakr L,Dutau H.Massive hemoptysis:an update on the role of bronchoscopy in diagnosis and management[J].Respiration,2010,80(1):38-58.DOI:10.1159/000274492.
[16] Zhang CJ,Jiang FM,Zuo ZJ,et al.Clinical characteristics and postoperative outcomes of systemic artery-to-pulmonary vessel fistula in hemoptysis patients[J].Eur Radiol,2022,32(6):4304-4313.DOI:10.1007/s00330-021-08484-7.
[17] Fruchter O,Schneer S,Rusanov V,et al.Bronchial artery embolization for massive hemoptysis:long-term follow-up[J].Asian Cardiovasc Thorac Ann,2015,23(1):55-60.DOI:10.1177/0218492314544310.
[18] Zhou Y,Tsauo J,Li Y,et al.Selective embolization of systemic collaterals for the treatment of recurrent hemoptysis secondary to the unilateral absence of a pulmonary artery in a child[J].Cardiovasc Intervent Radiol,2015,38(5):1312-1315.DOI:10.1007/s00270-014-0965-3.
[19] 杨阳,袁越,刘晖,等.支气管动脉肺动脉瘘15例分析[J].中华儿科杂志,2023,61(2):141-145.DOI:10.3760/cma.j.cn112140-20220513-00445. Yang Y,Yuan Y,Liu H,et al.Analysis of 15 cases of bronchial-pulmonary artery fistula[J].Chin J Pediatr,2023,61(2):141-145.DOI:10.3760/cma.j.cn112140-20220513-00445.
[20] Li H,Ding X,Zhai S,et al.A retrospective study on the management of massive hemoptysis by bronchial artery embolization:risk factors associated with recurrence of hemoptysis[J].BMC Pulm Med,2023,23(1):87.DOI:10.1186/s12890-023-02371-1.
[21] 况虹宇,向平,李谧,等.儿童血管相关性咯血介入治疗后复发因素的分析[J].中国小儿急救医学,2018,25(4):288-292.DOI:10.3760/cma.j.issn.1673-4912.2018.04.013. Kuang HY,Xiang P,Li M,et al.Analysis of pediatric hemoptysis recurrence related to vascular malformations after transcatheter occlusion[J].Chin Pediatr Emerg Med,2018,25(4):288-292.DOI:10.3760/cma.j.issn.1673-4912.2018.04.013.
[22] Zhu HH,Lv FF,Xu M,et al.Case report:hemoptysis caused by pulmonary tuberculosis complicated with bronchial artery-pulmonary artery fistula in children[J].Front Pediatr,2021,9:587342.DOI:10.3389/fped.2021.587342.
[23] 李静,高明明,吴长华,等.儿童咯血介入栓塞治疗后复发8例[J].介入放射学杂志,2020,29(10):1021-1024.DOI:10.3969/j.issn.1008-794X.2020.10.013. Li J,Gao MM,Wu CH,et al.Recurrence of hemoptysis after interventional embolization in children:a report of 8 cases[J].J Intervent Radiol,2020,29(10):1021-1024.DOI:10.3969/j.issn.1008-794X.2020.10.013.
Memo
收稿日期:2024-3-14。
基金项目:儿童急救医学湖南省重点实验室(2018TP1028);湖南省卫生健康委科研计划课题(202206013971)
通讯作者:段效军,Email:dxj801010@126.com