Вестник хирургии имени И.И. Грекова (Oct 2024)
Pulmonary hemorrhage in oncologic patients – a diagnostic algorithm
Abstract
The OBJECTIVE was to develop a diagnostic algorithm in oncologic patients with pulmonary hemorrhage.METHODS AND MATERIAL. A retrospective single-center study of the medical records of 258 patients who met the inclusion criteria was conducted. Inclusion criteria: age over 18 years, oncologic disease of the chest organs complicated by pulmonary hemorrhage. Inclusion criteria: age over 18 years, oncologic disease of the chest organs complicated by pulmonary hemorrhage. Exclusion criteria: age under 18 years, pulmonary hemorrhage of non-oncologic etiology. Pulmonary hemorrhage was considered to be the discharge of any volume of fresh blood or clots from the tracheobronchial tree, which was determined on the basis of anamnesis, clinical manifestations in the hospital, endoscopic examination. Routine diagnostic methods of investigation, such as chest radiography, chest computed tomography (including with contrast enhancement), fibrotracheobronchoscopy, bronchial arteriography were evaluated.RESULTS. The sensitivity for diagnosing the oncologic process in chest radiography, computed tomography, and fibrotracheobronchoscopy, was 84.7 %, 98.4 %, and 94.4 %, respectively. The sensitivity of fibrotracheobronchoscopy to detect the bleeding itself in oncologic patients reached 31.3 %, and the sensitivity of bronchial arteriography to diagnose the source of bleeding was 87.7 %.CONCLUSION. In pulmonary hemorrhage of oncologic genesis, the combination of fibrotracheobronchoscopy with computed tomography has sensitivity in 100 % of cases in determining the source and localization of the pathological process. Bronchial arteriography allows to perform endovascular hemostasis. It is necessary to conduct multicenter studies in order to develop and implement a unified algorithm assessing all etiopathogenetic features of pulmonary hemorrhage in oncologic patients.
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