Etiology Investigation And Clinical Diagnosis Analysis On Patients With Hemoptysis As The Main Complaint

Objective:The aim of this study is to review the clinical characteristics, diagnosis and treatment strategies of children with hemoptysis as the main complaint.Methods:This study was a retrospective study. We reviewed retrospectively all patients with hemoptysis as the main complaint admitted to Children’s Hospital, Zhejiang University School of Medicine during January 2005 and October 2015. Clinical charts were reviewed, and clinical characteristics, laboratory and imaging diagnosis results of the patients were recorded. We excluded all patients with gastrointestinal tract bleeding, oral mucosa bleeding or nose bleeding.Result:A total of 87 patients with hemoptysis as the main complaint were admitted during the study period. Among them,49 were males and 38 females with a male to female ratio of 1.3. The median age of the patients was 5.6 years, with a range of 31 days to 12 years 5 months. Among the patients,17 patients were under 1 year of age,15 were 1-3 years of age,21 were 3～7 years of age and 34 were 7-12 years of age.The duration of hemoptysis raged from 1 day to 3 years. The quantity of hemoptysis varied in these patients; totally 62 patients had mild hemoptysis with bleeding of less than 20 mL,13 moderate hemoptysis between 20 mL to 100 mL, and 8 with significant severe bleeding of more than 100 mL. Low hemoglobin was found in 21 patients, mild anemia in 15 (Hb≥90 g/L), moderate anemia in 5 (Hb 60-<90 g/L) and severe anemia in 1 (Hb<60 g/L). Twenty-five patients had multiple associated conditions. Thirteen patients had congenital heart defects.All patients had normal blood coagulation ability. Laboratory analysis revealed one patient with positive Chamydia pneumoniae antibodies, one with positive paragonimus antibodies. Bronchoalveolar lavage fluid analysis revealed 4 patients with positive lung hemosiderin cells. Two patients had positive PPD results. Fiberoptic bronchoscope analysis was performed in 17 patients. All the 17 patients were revealed to have bronchial inflammation. One patient had blood clots in the blonchus,2 had granuloma (due to foreign bodies), one had foreign body and one with mucosa bleeding associated with infection. CT was performed in 31 patients,19 had pneumonia-like changes (pachy or funicular, increased lung markings),4 had exudative lesions,2 with ground-glass changes and sporadic nodules both in the lungs,2 bronchiectasis and one lung consolidation. In the 13 patients with history of congenital heart defects, echocardiography was performed and all patients had heart or vascular defects. Cardial catheterization angiography in 9 patients revealed one with pulmonary arterio-venous fistula,3 with aortic coarctation,2 with pulmonary dysplasia,4 with congenital heart defects associated with vascular deformity. CTA was done in two patients, which revealed one with pulmonary sequestration with right pulmonary dysplasia and one normal. Nine patients had unknown causes.Radiographic studies and brochoscopy findings revealed the etiology in the patients. Thirty-seven were due to respiratory infection (42.5%),21 cadiovascular diseases (24.1%),5 bronchiectasis (5.7%),4 foreign body inspiration (4.6%),4 immunity related diseases (pulmonary hemosiderosis) (4.6%),3 deformity of respiratory tract (3.5%) and 11 unknown causes (12.6%).Hemoptysis due to respiratory tract infection, immunity-related diseases, bronchiectasis, bronchial foreign bodies were similar during different age groups. Cardiovascular diseases mostly occur in pre-school and school children. The causes of hemoptysis had no significant difference in gender. The volume of hemoptysis was few due to respiratory tract infections. The volume of hemoptysis due to cardiovascular diseases and bronchiectasis was more largeA total of 87 patients were given hemostatics, among them 10 were given hypophysin,2 without any treatment and 4 were only given antibiotics after removal of forein bodies from the respiratory tract.Conclusions:Hemoptysis often occur in preschool and school children. No age and gender differences were found in the patients with hemoptysis. Respiratory tract infections were the leading cause of hemoptysis in the studied patients, which is similar in different age groups; and congenital heart associated cardiovascular anomalies were the second cause, the prevalence of hemoptysis caused by CHD increased with age. The volume of hemoptysis is few due to respiratory tract infections and bronchiectasis. The volume of hemoptysis due to cardiovascular diseases and bronchiectasis.is large. X-ray is the primary screening method for hemoptysis, high-resolution CT can increase the diagnosis rate; CTA and DSA are the golden standards for diagnosis of hemoptysis caused by cardiovascular diseases.