以反复咯血为首发表现的风湿性心脏病二尖瓣狭窄临床误诊分析OA

Objective To investigate the clinical characteristics,causes of misdiagnosis,and preventive measures of rheumatic mitral stenosis presenting with recurrent hemoptysis as the initial symptom.Methods A retrospective analysis was conducted on the clinical data of 7 patients with rheumatic mitral stenosis misdiagnosed as respiratory diseases from January 2018 to December 2024.Results All 7 patients presented with recurrent hemoptysis as the initial symptom.Three patients with recurrent hemoptysis and pulmonary imaging showing cylindrical bronchiectasis signs were misdiagnosed with bronchiectasis,2 patients with young age of onset,recurrent episodes,and pulmonary linear opacities were misdiagnosed as pulmonary tuberculosis,and 2 patients with acute hemoptysis and pulmonary patchy opacities were misdiagnosed as pulmonary infection.After corresponding treatment,hemoptysis was poorly controlled or symptoms such as exertional dyspnea and paroxysmal nocturnal dyspnea developed,leading to re-evaluation.Following detailed medical history inquiry(including a definite history of rheumatic fever in 2 patients)and careful cardiac auscultation(diastolic rumbling murmur heard at the apex in 6 patients),all patients were diagnosed with severe rheumatic mitral stenosis by echocardiography,including 4 patients with significant left atrial enlargement and 3 patients with mild pulmonary hypertension.The misdiagnosis duration ranged from 10 d to 8 months.After diagnosis,2 patients received medical treatment due to refusal of surgery,and 5 patients underwent percutaneous balloon mitral valvuloplasty.During follow-up ranging from 6 months to 2 years,the 5 patients who underwent surgery had complete resolution of hemoptysis,and their cardiac function improved to New York Heart Association(NYHA)class Ⅰ-Ⅱ.Among the 2 patients receiving drug therapy,1 had occasional blood-streaked sputum without major hemoptysis,and 1 experienced recurrent hemoptysis once due to acute left heart failure induced by pulmonary infection,which was controlled after treatment.No hemoptysis-related deaths occurred during the follow-up period.Conclusion Rheumatic mitral stenosis presenting with recurrent hemoptysis as the initial symptom is easily misdiagnosed as respiratory diseases such as bronchiectasis,pulmonary tuberculosis,and pulmonary infection.When patients with hemoptysis lack typical features of respiratory diseases or show poor response to treatment,cardiogenic hemoptysis should be considered.Timely cardiac auscultation and echocardiography may be key to avoiding misdiagnosis.