# 出血（Hemorrhage）

- 器官 / 系统：骨骼肌 / 骨骼肌肉系统（skeletal-muscle / musculoskeletal-system）
- NTP 数据编号：ntp-0585
- 规范 URL：https://www.labsmart.cn/ntp/skeletal-muscle-hemorrhage.html
- 中文图谱总页锚点：https://www.labsmart.cn/ntp-atlas.html#skeletal-muscle-hemorrhage
- 原始出处：https://ntp.niehs.nih.gov/atlas/nnl/musculoskeletal-system/skeletal-muscle/Hemorrhage
- 授权：美国联邦政府作品，公有领域；引用请标注 NTP Nonneoplastic Lesion Atlas
- 适用说明：仅供科研使用，不用于临床诊断

## 一句话结论
肌肉内出血与其他组织中的出血一样，在组织学上以血液在血管外积聚为特征，就骨骼肌而言，积聚的血液分离并包绕（Figure 1、Figure 2、Figure 3）相邻的肌纤维，在某些情况下还会使其结构消失（Figure 4）。

## 病变描述（中文）
肌肉内出血与其他组织中的出血一样，在组织学上以血液在血管外积聚为特征，就骨骼肌而言，积聚的血液分离并包绕（Figure 1、Figure 2、Figure 3）相邻的肌纤维，在某些情况下还会使其结构消失（Figure 4）。根据病变的原因和严重程度，受累区域的肌纤维可能相对不受影响（Figure 1、Figure 2、Figure 3），也可能发生变性和/或坏死性改变。病变范围可从局灶性（focal）、离散到广泛、弥漫。出血区域内出现含铁血黄素负载的巨噬细胞（Figure 5、Figure 6）提示存在一定程度的慢性化。肌内出血通常发生于肌肉受到损伤之后，如钝性创伤、肌内注射（注射部位）或炎症。原发性血管病变，如动脉瘤和血管炎，以及血小板或凝血因子异常，也可导致肌内出血。

## 诊断与分级建议（NTP 共识，中文）
当肌内出血作为原发性且显著的变化存在时，应予以诊断，并根据病变范围赋予严重程度分级。病理学家应全面评估组织，以尽可能确定出血的原发原因（例如原发性血管病变、创伤证据）。继发性肌病性改变无需单独记录，除非其严重程度足以需要记录，但应在病理学叙述中予以描述。

## 英文原文 · Comment
Hemorrhage in muscle, as in other tissues, is histologically characterized by the extravascular accumulation of blood, which in the case of skeletal muscle separates and surrounds ( Figure 1 , Figure 2 , and Figure 3 ), and in some instances effaces ( Figure 4 ), adjacent muscle fibers. Depending upon the cause and severity of the lesion, myofibers in affected regions may remain relatively unaffected ( Figure 1 , Figure 2 , and Figure 3 ) or undergo degenerative and/or necrotic changes ( Figure 4 ). Lesions can range from focal and discrete to extensive and widespread. The presence of hemosiderin-laden macrophages within a region of hemorrhage ( Figure 5 and Figure 6 ) implies some degree of chronicity. Intramuscular hemorrhage typically occurs following an insult to the muscle, such as blunt trauma, intramuscular injection (injection site), or inflammation. Primary vascular lesions, such as aneurysms and vasculitis, and abnormalities in platelets or coagulation factors can also result in intramuscular hemorrhage.

## 英文原文 · Recommendation
When present as a primary and significant change, intramuscular hemorrhage should be diagnosed and assigned a severity grade based on the extent of the lesion. The pathologist should thoroughly evaluate the tissue in an attempt to determine the primary cause of the hemorrhage (e.g., primary vascular lesions, evidence of trauma). Secondary myopathic changes do not need to be recorded separately unless warranted by severity but should be described in the pathology narrative.

## 配图
- https://www.labsmart.cn/ntp-atlas-images/ntp_0544.jpg
- https://www.labsmart.cn/ntp-atlas-images/ntp_0545.jpg

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