Overview of hemorrhagic infarction
Hemorrhagic infarction (hemorrhagic infarction), commonly found in the lungs, intestines and other organs with double blood circulation, loose tissue structure, and in the case of severe bruising, due to the infarct foci of a large amount of bleeding, so it is called hemorrhagic infarction, also known as red infarction. It is advisable to find out the primary disease that causes hemorrhagic infarction and treat the cause of the disease.
Causes
1. Severe bruising
When the organs have severe bruising, the infarction caused by vascular obstruction is hemorrhagic infarction, such as pulmonary bruising. Severe bruising is an important prerequisite for the formation of pulmonary infarction, because in the case of pulmonary bruising, the pulmonary veins and capillaries increase in pressure, affecting the establishment of effective pulmonary artery and bronchial artery collateral circulation after the pulmonary artery branches are blocked, resulting in hemorrhagic infarction of the lung.
2. Loose tissue
The tissues of intestine and lung are loose, and the loose tissue space in the early stage of infarction can accommodate a large amount of leaking blood, and when the tissue necrosis absorbs water and expands, the leaking blood can not be extruded out of the infarct foci, and thus the infarct foci are hemorrhagic. If the lung is solid due to inflammation, the infarction is usually hemorrhagic.
3. Common diseases and typical symptoms
(1) Pulmonary hemorrhagic infarction is often located in the lower lobe of the lungs, especially in the septal margins of the ribs, often multiple, the lesions are of different sizes, conical (wedge), the tip of the tip of the lungs towards the lung doors, the bottom of the bottom of the lungs next to the lung membranes, and there is a fibrous exudate on the surface of the lung membranes.
(2) Intestinal hemorrhagic infarction Mostly seen in mesenteric artery embolism and venous thrombosis, or hemorrhagic infarction caused by intussusception, intestinal torsion, incarcerated hernia, and tumor compression.
(3) Cardio-cerebral syndrome in the elderly Convulsions, hemorrhagic infarction, conduction block, mitral valve prolapse and so on.
(4) Intracranial venous sinus occlusion cranial hypertension Congestion, convulsions, hemorrhagic infarction, localization signs, nausea, vomiting, etc.
Differential diagnosis
1. History of hemorrhage
If bleeding is present since childhood, bleeding after minor injury, trauma or minor surgery, hereditary bleeding disorder should be considered. Bleeding in adulthood should be considered acquired, and the primary disease should be found. Skin and mucous membrane purpura with abdominal pain, arthralgia, and normal platelets should be considered allergic purpura. Thrombocytopenic purpura should be considered if there is skin and mucous membrane purpura, heavy menstruation, and low platelet count, which is more common in women.
2. Physical examination
Attention should be paid to the nature and location of bleeding. Allergic purpura occurs in the two lower limbs and buttocks, varying in size, symmetrically distributed, and may be accompanied by rash and urticaria. Thrombocytopenic purplish scar or platelet dysfunction disease is often pinpoint hemorrhagic spots, with generalized scattered distribution. Scurvy presents as perifollicular hemorrhages. Hereditary trichiasis with vascular nevi on the lips, tongue and cheeks. Enlarged liver and spleen, enlarged lymph nodes, and jaundice may provide a clinical diagnosis of the primary disease.
3. Differentiation between primary cerebral hemorrhage and cerebral tumor hemorrhage
(1) Primary cerebral hemorrhage is mainly based on the following clinical features: (1) Sudden onset during physical activity or emotional excitement. ② rapid onset, within a few minutes or a few hours, symptoms of limb dysfunction and increased intracranial pressure, headache, nausea and vomiting. ③ There are neurological localization signs. ④ Previous history of hypertension, especially those who have not undergone formal treatment. ⑤ Brain CT scanning examination: there is a high-density shadow at the time of illness, surrounded by a low-density edema band with occupying effect, and it can accurately display any hematoma with a diameter of more than 1.5cm. It can determine the location of hemorrhage, the size of hematoma, whether it breaks into the ventricle, whether there is cerebral edema and cerebral hernia formation. On the other hand, hemorrhagic cerebral infarction is the clinical manifestation of cerebral infarction first, and hemorrhagic lesions occur on the basis of cerebral infarction. Hemorrhagic cerebral infarction is a complication of cerebral infarction, and the term “hemorrhagic transformation” has been replaced by “hemorrhagic cerebral infarction. The pathology of hemorrhagic cerebral infarction is mainly due to the presence of small arteries, capillaries and/or small veins in the infarcted area, which are damaged by ischemia and hypoxia, as well as the phenomenon of reperfusion, which leads to the spillage of erythrocytes from the blood.
(2) Cerebral aneurysmal hemorrhage Patients with cerebral aneurysmal hemorrhage usually have symptoms of increased intracranial pressure, such as headache, nausea, and vomiting, and on examination, there is optic disc edema and neurological localization of the signs, on which the condition suddenly worsens. CT scan of the brain shows high density within the cystic changes or necrotic areas of the brain tumor, and blood planes are seen. Sometimes inhomogeneous hyperdense shadow can be seen. There is enhancement of the tumor tissue on enhancement scan.
Examination
1. Platelet adhesion function
Generally, the glass bead column method is used to count the number of platelets before and after adhesion and calculate the adhesion rate.
2. Platelet aggregation function
Add different aggregation inducers such as epinephrine, ADP, collagen, thrombin, ristocetin, etc., and measure the speed and intensity of the first wave of aggregation and the second wave of aggregation caused by the release reaction.
3. Prothrombin consumption test
That is, serum thromboplastin time, mainly to determine the activity of the first step product of coagulation. Now there is activated thromboplastin time, so this method has been less used.
4. Cerebrospinal fluid examination
Lumbar puncture is only carried out when CT examination cannot be done and it is difficult to distinguish cerebral infarction and cerebral hemorrhage in clinic, and usually the cerebral pressure and CSF routine are normal.
5. Blood, urine, stool routine and biochemical examination
Mainly related to the risk factors of cerebrovascular disease, such as hypertension, diabetes mellitus, hyperlipidemia, heart disease, atherosclerosis and so on.
Treatment principle
Find out the primary disease causing hemorrhagic infarction and treat it according to the cause.