发热咳嗽后大“咯血”休克

"Massive hemoptysis" and shock after fever and cough

摘要:

11岁男性患儿，因间断发热15 d，咳嗽10 d，“咯血”7 d入院。患儿15 d前以发热咳嗽起病，伴左侧颈部疼痛，抗生素治疗有效。病程中突然出现大“咯血”致休克，后经纤维支气管镜检查发现左侧梨状窝内瘘口并持续渗血，结合颈部及血管影像学检查考虑为先天性梨状窝瘘感染并颈部脓肿致颈内静脉受损血栓形成，通过低温等离子消融梨状窝瘘封闭术治疗后好转，随访1年半未反复。检索文献未发现梨状窝瘘感染引起大出血休克报道，该文总结此例患儿的临床特点及诊治经过，为早期诊断该类疾病及其并发症防治提供参考依据。

Abstract:

A boy, aged 11 years, was admitted due to intermittent fever for 15 days, cough for 10 days, and "hemoptysis" for 7 days. The boy had fever and cough with left neck pain 15 days ago, and antibiotic treatment was effective. During the course of disease, the boy developed massive "hemoptysis" which caused shock. Fiberoptic bronchoscopy revealed a left pyriform sinus fistula with continuous bleeding. In combination with neck and vascular imaging examination results, the boy was diagnosed with internal jugular vein injury and thrombosis due to congenital pyriform sinus fistula infection and neck abscess. The boy was improved after treatment with temperature-controlled radiofrequency ablation for the closure of pyriform sinus fistula, and no recurrence was observed during the follow-up for one year and six months. No reports of massive hemorrhage and shock due to pyriform sinus fistula infection were found in the searched literature, and this article summarizes the clinical features, diagnosis, and treatment of this boy, so as to provide a reference for the early diagnosis of such disease and the prevention and treatment of its complications.