Hemorrhagic infarction

Introduction Hemorrhagic infarction occurs in organs that are loose in tissues, such as the lungs and intestines. Another important condition is severe tissue congestion. When local tissue is necrotic due to blood supply disorders, it generally looks dark red, soft, and coagulated under the microscope. Sexual necrosis, and see a lot of red blood cells. Infarction can be divided into septic infarct and simple, non-infectious infarction according to the presence or absence of bacterial infection. The former embolus contains bacteria, so there is a bacterial infection in the infarct. In acute bacterial endocarditis, an embolic abscess can be caused by embolization caused by a bacterial embolus that is detached from the heart valve.

Cause

Hemorrhagic infarction occurs under the following conditions:

(1) Severe congestion: When the organ is severely bruised, the infarction caused by vascular obstruction is hemorrhagic rather than anemia. For example, when the ovarian tumor is twisted in the ovary pedicle, the venous return is stopped, the arterial blood supply is stopped, the ovarian tumor tissue is necrotic, and the blood leaks out from the capillaries of the blood to form a hemorrhagic infarction. Pulmonary infarction occurs mostly in patients with pre-requisites for left heart function compensatory incompleteness. At this time, pulmonary congestion is the cause of bleeding in the infarct.

(2) loose tissue: the tissues of the intestines and lungs are loose. When the infarction starts, the amount of bleeding in the interstitial space can be accommodated. When the tissue is necrotic and inflated, the leaked blood can not be squeezed out of the infarct, so the infarct is Hemorrhagic. However, if the lungs first become confounded by pneumonia, the pulmonary infarction that occurs is generally anemia rather than hemorrhagic.

It should be noted that the prerequisite for the occurrence of pulmonary infarction is the presence of pulmonary congestion in advance. This is because the lung has a dual blood supply of pulmonary artery and bronchial artery. There is a rich anastomosis between the two. Under the condition of normal pulmonary circulation, pulmonary artery embolization does not cause infarction, because the bronchial artery can supply blood to the lung by means of anastomosis. Tissue; however, if the lungs have been congested, the pulmonary venous pressure is increased. When the pulmonary artery branches are embolized, the pressure of the bronchial artery alone is not enough to overcome the local pulmonary vein resistance, and the local lung tissue is infarcted. This is why pulmonary infarction is common in mitral valve disease and is a cause of hemorrhagic disease.

The hemorrhagic infarction of the lung is a conical lesion with a lung membrane pointing to the hilar, dark red, and the microscopic structure of the hemorrhagic infarct tissue is tissue necrosis with diffuse hemorrhage.

Hemorrhagic infarction also often occurs in the intestines. Intussusception, intestinal torsion, incarcerated hemorrhoids can cause hemorrhagic infarction in the local intestine, and the intestine is dark red in the naked eye.

Infarction can be divided into septic infarct and simple, non-infectious infarction according to the presence or absence of bacterial infection. The former embolus contains bacteria, so there is a bacterial infection in the infarct. In acute bacterial endocarditis, an embolic abscess can be caused by embolization caused by a bacterial embolus that is detached from the heart valve.

an examination

(1) Platelet adhesion function: The number of platelets before and after adhesion was counted by a glass bead method, and the adhesion rate was calculated.

(2) Platelet aggregation function: Different aggregating agents such as adrenaline, ADP, collagen, thrombin and ristocetin were added to determine the speed and intensity of the second wave aggregation caused by the first wave of aggregation and the release reaction.

(3) Prothrombin consumption test: that is, serum prothrombin time, mainly to determine the activity of the first product of blood coagulation, and there is now a time to activate thromboplastin, so this method has been used less.

Differential diagnosis

The tendency to hemorrhage is a common manifestation of many different diseases and different causes of bleeding. In order to clarify the reasons, clinical and laboratory data must be comprehensively analyzed to understand the patient's past history and to combine the current bleeding conditions to arrive at the correct conclusion. Among them, laboratory tests are more important.

(1) To examine the history of hemorrhagic diseases, such as bleeding from childhood, minor injuries, trauma, or bleeding after minor surgery. Should be considered as hereditary hemorrhagic disease; adult bleeding should consider the acquisition of more, need to find the primary disease; skin, mucosal purpura with abdominal pain, joint pain and normal platelets should consider allergic purpura; skin mucosa purpura, menstrual volume Many, low platelet counts need to consider thrombocytopenic purpura, more women.

(2) Physical examination should pay attention to the traits and parts of bleeding. Allergic purpura occurs in both lower limbs and buttocks, varies in size, is symmetrically distributed, and can be accompanied by rashes and urticaria. Thrombocytopenic purpura or platelet dysfunction is often a needle-like bleeding site with a systemic scattered distribution.

The blood disease manifests as bleeding around the hair follicle. Hereditary telangiectasia has vasospasm in the lips, tongue, and cheeks. Hepatosplenomegaly, lymphadenopathy, jaundice, etc., can provide a clinical diagnosis of primary disease.

Differential diagnosis:

Hemorrhagic cerebral infarction also has hemorrhagic lesions on CT findings. It should be differentiated from primary cerebral hemorrhage and brain tumor hemorrhage. Sometimes it is necessary to have a original CT slice to confirm the diagnosis.

Primary cerebral hemorrhage

Since the advent of CT, the clinical diagnosis of cerebral hemorrhage has not been difficult.

The main clinical basis:

(1) Sudden onset of physical activity or emotional agitation.

(2) Onset of illness, symptoms of limb dysfunction and increased intracranial pressure in a few minutes or hours, may have headache, nausea and vomiting.

(3) There are signs of nervous system localization.

(4) History of previous hypertension, especially those who have not undergone regular treatment.

(5) Brain CT scan: There is a high-density shadow at the time of the disease, and there is a mass effect around the low-density edema zone. The hematoma with a diameter greater than 1.5 cm can be accurately displayed. It can determine the location of the hemorrhage, the size of the hematoma, whether it breaks into the ventricle, whether there is brain edema and cerebral palsy, almost 100% diagnosis. Hemorrhagic cerebral infarction is a clinical manifestation of cerebral infarction, and hemorrhagic lesions occur on the basis of cerebral infarction.

2. Brain tumor hemorrhage

Patients with brain tumor hemorrhage often have symptoms of increased intracranial pressure such as headache, nausea, vomiting, and examination of optic disc edema and signs of nervous system localization. On this basis, the condition suddenly aggravates, and the brain CT scan shows: cystic changes of brain tumor or The density in the necrotic area is high and the blood plane is visible. Uneven high density shadows are sometimes seen. The tumor tissue has an enhanced response during enhanced scanning.

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