Coughing up blood should raise suspicion of bronchiectasis.

SKĐS - Bronchiectasis is a chronic condition affecting the airways in the lungs (also called bronchi), leading to thickening and widening of the airway walls beyond normal, and irreversible damage.

A 70-year-old man is in a deep coma due to severe hemoptysis caused by bronchiectasis.

A 70-year-old man residing in Nui Thanh commune, Da Nang city, was admitted to Quang Nam Central General Hospital in a coma, experiencing difficulty breathing, massive hemoptysis, severe respiratory failure, and a blood oxygen saturation (SpO2) of only 65%.

Upon admission, doctors promptly intubated the patient, suctioned blood clots from both lungs, provided mechanical ventilation, transfused blood, and offered intensive care to maintain life. A CT scan confirmed that the patient had localized bronchiectasis in the lower lobe of the right lung, which was the cause of the severe hemoptysis.

Following a multidisciplinary consultation, the team decided to perform a laparoscopic right lower lobectomy to control bleeding and remove the damaged area. The surgery was successful, the patient stopped coughing up blood, recovered quickly, and has now been discharged from the hospital.

This is a fortunate case of a patient being saved after falling into a deep coma due to severe hemoptysis caused by bronchiectasis, thanks to early detection and timely treatment.

What causes bronchiectasis?

Bronchiectasis is a condition that can occur at any age, from very young patients to the elderly.

There are many causes of bronchiectasis, the most common of which are:

Congenital defects

• Kartagener syndrome: diffuse bronchiectasis accompanied by sinusitis and situs inversus (reversal of the internal organs).
  
• Williams-Cambell syndrome: a defect or absence of bronchial cartilage, causing the bronchi to expand during inhalation and collapse during exhalation.
  
• Mounier-Kunhn syndrome: bronchiectasis due to structural defects in the connective tissue of the bronchial wall, accompanied by bronchiectasis.

Due to necrotizing inflammation of the bronchial wall.

Bronchiectasis can result from lung infections such as tuberculosis, bacterial or viral pneumonia, measles, whooping cough, aspiration of gastric contents, inhalation of toxic fumes (ammonia), or recurrent bronchial infections.

Due to cystic fibrosis.

Bronchiectasis accounts for 50% of cystic fibrosis cases, most commonly seen in Europe and North America. Bronchiectasis usually appears in the late stages of the disease.

Due to bronchial obstruction

Bronchial lymphadenitis, bronchial foreign bodies, bronchial tumors, or fibrotic scarring can cause bronchial strictures. Below the narrowed bronchus, intrabronchial pressure increases, and bronchial secretions accumulate, leading to chronic local infection and eventually developing into bronchiectasis.

Granulomatous fibrotic lesions causing bronchial wall retraction.

Pulmonary fibrosis, cavitary tuberculosis, chronic lung abscess, and fibrotic alveolar disease. The lung parenchyma is destroyed and fibrotic, leading to retraction and irreversible bronchiectasis. Because most cases of post-primary pulmonary tuberculosis primarily affect the apical lobe and posterior segments of the upper lobe, bronchiectasis is commonly found in these locations, with hemoptysis being a frequent symptom.

Mucovicular clearance disorders

• Primary ciliary dyskinesia syndrome.
  
• Secondary ciliary dyskinesis due to asthma. In these cases, bacteria typically proliferate in the lower respiratory tract.
  
• Disruption of the lung's protective mechanisms.
  
• Congenital or acquired immunodeficiency such as hypogammaglobulinemia, selective IgA, IgM, and IgG deficiency.
  
• Acquired immunodeficiency: caused by immunosuppressive drugs, HIV/AIDS infection, multiple myeloma, malignant leukemia.
  
• Allergic bronchial fungal infection caused by Aspergillus
  

This is a subtended immune response and deposition of precipitating antibodies (IgM, IgG) in the bronchial walls, the consequence of this type III immune response being bronchiectasis (according to Gell-Coombs) and the development of bronchiectasis. An excessive immune response can also occur after lung transplantation.

Manifestations of bronchiectasis

• Persistent cough with daily purulent sputum production is a very important symptom. Sputum production increases with secondary bronchial infections. In some cases, there is a dry cough without sputum (dry bronchiectasis in the upper lobe, often following pulmonary tuberculosis). Some cases show signs of pansinusitis causing bronchosinobronchial syndrome.
  
• Sputum has three layers: the top layer is foam, the bottom layer is pus, and the base layer is mucus. Sputum may have a foul odor when there is a bacterial infection.
  
• Hemoptysis: The dry form primarily involves coughing up blood without sputum. Hemoptysis is less common in children. It can recur many times and last for many years. The severity ranges from mild to severe. Hemoptysis may be the only symptom of the disease.
  
• Dyspnea is also a common symptom, often seen in patients with concomitant emphysema.
  
• Chest pain: This can be an early sign of bronchial infection in the area of ​​bronchiectasis.
  
• The prolonged illness leads to weight loss, anemia, fatigue, and clubbed fingers.
  
• Shortness of breath and cyanosis may occur if bronchiectasis is widespread in both lungs.
  

In summary: Bronchiectasis is a condition that can occur at any age, from very young patients to the elderly. The disease has many different causes, and identifying the cause is a crucial step in effective treatment. Therefore, when experiencing any unusual symptoms, it is necessary to seek medical attention for examination and treatment.

Source: https://suckhoedoisong.vn/ho-ra-maucan-canh-giac-voigian-phe-quan-169251113190643636.htm