Case Of Massive Hemoptysis Research Articles

The First Case of Bernard-Soulier Syndrome Presenting with Isolated Hemoptysis and Probable Diffuse Alveolar Hemorrhage: A Case Report and Literature Review

Bernard-Soulier syndrome (BSS) is a rare platelet function disorder due to an impaired GPIb-V-IX complex, with an estimated incidence of one per million. Usual presentations include gingival bleeding, epistaxis, easy bruising, and post-traumatic excessive bleeding, among others, but not hemoptysis. The patient was a 46-year-old male who presented with three cups of hemoptysis two days before the presentation. He also had moderate burning chest pain for the past two weeks, which was getting better. He was diagnosed with BSS 45 years ago and had approximately 100 prior presentations for bleeding from various locations, including three prior episodes of hemoptysis. The mainstay of treatment was platelet transfusions, and the patient was carefully observed. Only one case of hemoptysis in a patient with BSS was found, but the patient had hemoptysis due to underlying pulmonary tuberculosis. Therefore, hemoptysis or DAH were never reported in the literature due to BSS. This patient was the first case of massive hemoptysis and possible DAH related to BSS, emphasizing the need for proper attention due to its possible detrimental outcomes.

Treatment of massive hemoptysis after thoracic aortic aneurysm repair

BackgroundMassive hemoptysis after thoracic aortic aneurysm (TAA) repair is a rare but potentially lethal condition. Endovascular management is a challenging treatment option due to the complexity of culprit vessel access.Case presentationAn 81-year-old woman was referred to our hospital with massive hemoptysis. She had a history of graft replacement and thoracic endovascular aortic repair (TEVAR) for dissecting TAA. Computed tomography (CT) showed massive atelectasis with hematoma in the left lower lung lobe adjacent to the descending aortic aneurysm treated with TEVAR. Contrast-enhanced CT revealed a pseudoaneurysm and proliferation of abnormal vessels at the peripheral side of the left pulmonary ligament artery (PLA) in the atelectasis. The PLA continued to the right subscapular artery via a complex collateral pathway. Diagnostic angiography of the right subcapsular artery revealed a pseudoaneurysm and abnormal vessels at the peripheral side of the left PLA with a systemic-pulmonary artery shunt. Transcatheter arterial embolization (TAE) for the left PLA via the collateral pathway with N-butyl cyanoacrylate achieved complete embolization. The patient’s hemoptysis was controlled and she was discharged.ConclusionsHere we presented a case of massive hemoptysis due to PLA disruption that occurred after TAA repair. TAE via a complex collateral pathway is a feasible and effective treatment for hemoptysis, even in patients who have undergone surgical or endovascular TAA repair.

A case of massive hemoptysis after radiofrequency catheter ablation for atrial fibrillation.

A case of massive hemoptysis after radiofrequency catheter ablation for atrial fibrillation.

Unusual case of massive hemoptysis in young male

Unusual case of massive hemoptysis in young male

Removal of hematoma due to massive hemoptysis after transbronchial biopsy: a case report

BackgroundMassive hemoptysis is a life-threatening complication after transbronchial biopsy (TBB). Reports on massive hemoptysis occurring several days after TBB are scarce.Case presentationA 62-year-old man presented with massive hemoptysis and was admitted to hospital as an emergency on the eighth day after TBB. On the 12th day after TBB, computed tomography showed complete atelectasis of the right middle and lower lobes. The patient underwent emergent right upper lobectomy. The right upper lobe bronchus was separated with a scalpel, the hematoma was pulled out with forceps, and the bronchus subsequently sutured shut. The patient was discharged from the hospital uneventfully.ConclusionsWe experienced a case of massive hemoptysis on the eighth day after TBB, which required emergency surgery due to persistent bleeding into the airway and airway obstruction during follow-up. Postoperative pneumonia and atelectasis could be prevented by manual removal of the residual hematoma.

Massive Pulmonary Hemorrhage from Bronchial Varix

Bronchial varix is a rare pulmonary disorder which may lead to life-threatening hemorrhage. Diagnosis is difficult because of the subtle abnormalities on radiographic and bronchoscopic examination. We present a case of massive hemoptysis from a bleeding bronchial varix. In the absence of immediate complex endobronchial therapy in the island of Guam, this case was initially managed with nebulized and intravenous tranexamic acid. This was followed by endobronchial blockade of the bleeding airway with endobronchial epinephrine instillation. Selective bronchial artery embolization alleviated the acute-phase bleeding. Prone positioning was initiated due to severe hypoxia after blood clots compromised the patency of bilateral bronchial airways. Prone ventilation was employed for 17 hours for 2 consecutive days with intermittent bronchoscopic forceps extraction of airway blood clots while in the prone position. These maneuvers resulted to improved lung ventilation and oxygenation. The patient underwent bronchial sleeve resection surgery for definitive management.

A rare case of massive hemoptysis: Long-term complication of thoracotomy; rib fracture

A rare case of massive hemoptysis: Long-term complication of thoracotomy; rib fracture

Hemoptysis: Rethinking Management

Hemoptysis is a distressing symptom that necessitates urgent investigation. Despite its prevalence, there is frequent uncertainty regarding the etiology, clinical trajectory, and therapeutic management of hemoptysis. We aim to discuss the causes, diagnostic workup, and pragmatic management strategies for cases of massive and non-massive hemoptysis. Bronchoscopic techniques to control hemoptysis is an emerging area of study. Fogarty balloons and endobronchial blockers are often deployed to isolate the bleeding lung. Depending on the source of bleeding, a variety of endobronchial medical therapies, thermal technologies, and selective sealing methods can be utilized for hemostasis. Initial management of a patient presenting with hemoptysis consists of ensuring adequate airway protection and stabilization of hemodynamics. Following this, hemoptysis can be evaluated and controlled by bronchoscopy, embolization, and/or surgery. Additional research is needed to determine optimal timing of bronchoscopy and if differences in hemostatic techniques result in differences in outcomes, especially for cases of massive hemoptysis.

PULMONARY ARTERY PLUG EMBOLIZATION FOR TREATMENT OF HEMOPTYSIS

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Pulmonary artery plug embolization (PAE) is a procedure routinely used for treatment of AVMs and Rasmussen’s aneurysm. In theory it should be able to help reduce symptoms of refractory hemoptysis with other etiologies as well1. A review of the literature showed no other cases of PAE for refractory hemoptysis in the setting of advanced lung cancer in the United States. CASE PRESENTATION: This case report is to showcase an 83-year-old male who presented with massive hemoptysis and was treated using a novel and unconventional method.The patient had a known history of non-small cell lung cancer (NSCLC), Stage IIIA (T4N1M0) of the right upper lobe who had completed seven rounds of chemotherapy with Carboplatin and Gemzar. Massive hemoptysis led to hypoxemia with oxygen saturation in the 40’s and was intubated for airway protection. Emergent bronchoscopy was unsuccessful with airways full of bright red blood. Right upper lobe bronchus showed a large amount of active bleeding preventing distal visualization. Chest CT showed a new cavitary lesion, likely malignant from NSCLC. CT angiogram of chest without contrast concluded that the right upper lobe hemoptysis was likely secondary to pulmonary artery pseudoaneurysm. IR proceeded with a right PAE to control bleeding. After right PAE, fiberoptic bronchoscopy was repeated. The right upper lobe opening was visualized with no blood clot, and bronchus intermedius, middle and lower lobe openings were visualized. Acute respiratory failure resolved and patient was successfully extubated. Patient was discharged to have an outpatient CT scan to determine if a bronchoscopy with biopsy would be needed prior to proceeding with any further oncological treatment. DISCUSSION: Marcelin et al evaluated 19 patients treated for massive or recurrent hemoptysis with transarterial pulmonary artery embolization in France. Primary and assisted technical success rates were 73.7% (14/19) and 84.2% (16/19), respectively. They concluded that embolization is an effective and safe treatment of lung tumors with pulmonary arterial bleeding2. CONCLUSIONS: In our patient, PAE succeeded in controlling the massive hemoptysis and patient was successfully extubated. The extent to which this procedure affected the overall survival of this patient is unclear. However, respiratory failure resolved with control of the hemoptysis and patient was successfully extubated. PAE should at least be considered in similar cases when refractory hemoptysis is present. While bronchial artery embolization is the first line treatment in most cases of massive hemoptysis, our patient did not have dilated bronchial arteries to attempt this3. Reference #1: Yoon, W., Kim, J. K., Kim, Y. H., Chung, T. W., & Kang, H. K. (2002). Bronchial and Nonbronchial Systemic Artery Embolization for Life-threatening Hemoptysis: A Comprehensive Review. RadioGraphics, 22(6), 1395-1409. https://doi.org/10.1148/rg.226015180 Reference #2: Marcelin, C., Soussan, J., Desmots, F., Gaubert, J., Vidal, V., Bartoli, J. M., & Izaaryene, J. (2018). Outcomes of Pulmonary Artery Embolization and Stent Graft Placement for the Treatment of Hemoptysis Caused by Lung Tumors. Journal of Vascular and Interventional Radiology, 29(7), 975-980. https://doi.org/10.1016/j.jvir.2018.01.773 Reference #3: Barben J, Robertson D, Olinsky A, Ditchfield M Radiology. 2002 Jul; 224(1):124-30. DISCLOSURES: No relevant relationships by Raju Abraham, source=Web Response No relevant relationships by Naina Chandan, source=Web Response Scientific Medical Advisor relationship with Access Vascular Inc. Please note: $1001 - $5000 Added 03/13/2019 by Arun Jagannathan, source=Web Response, value=Ownership interest Scientific Medical Advisor relationship with IV Access Technologies Please note: $1001 - $5000 Added 03/13/2019 by Arun Jagannathan, source=Web Response, value=Ownership interest No relevant relationships by Kyle Kopatich, source=Web Response No relevant relationships by Dhaval Patel, source=Web Response

A Case of Massive Hemoptysis as a Catastrophic Complication After Photodynamic Therapy for Recurred Tracheal Malignancy

SESSION TITLE: Cardiothoracic Surgery SESSION TYPE: Global Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Photodynamic therapy is a useful treatment method for tracheal malignancy. However, it sometimes provokes disasterous complications such as dyspnea or hemoptysis. We experienced a case of fatal hemoptysis after photodynamic therapy for tracheal cancer and hereby reported. CASE PRESENTATION: A 37-year old woman was admitted to a hospital for the treatment of her recurred tracheal cancer. She received surgical resection followed by concurrent chemoradiation therapy for her large cell neuroendocrince carcinoma in trachea 3 years before. Photofrin was administrated intravenously at a dose of 2mg/kg. One day after, endoscopic tumor ablation was performed with a light diffusion catheter using a 630mm wavelength light sorce. The patient was given 120J for one session, with duration of 400 seconds. The patient was discharged without complications 5 days after the treatment initially. However, she visited emergency room complaining dyspnea. Bronchoscopic examination showed purulent sputum and ulcerative lesion in treatment lesion. After tolileting sputum and antibiotics administration, the symptom was relieved. At 10th day of hospital stay, she appealed severe dyspnea again and endoscopic toileting was performed. Although no specific signs or symptoms have been appeared for the next 3 days, a massive hemoptysis was suddenly developed. Despite the immediate intensive care, the patient expired on the 13th day of hospitalization. DISCUSSION: Photodynamic therapy has been proved to be feasible and safe for the treatment of airway cancers. However, a patient who had been performed photodynamic therapy and revealed symptoms such as dyspnea should be carefully observed to prevent the tragic results whch might be caused by complications. CONCLUSIONS: PDT is a useful modality for lung cancer in tracheobronchial trees. It could be applied for palliative purpose to reduce symptoms caused by tumor obstruction, or hemoptysis. PDT could be an excellent substitution of surgery for patients with severe comorbidities, or patients who refuse surgery. Risks for fatal complications should be evaluated before the practice. Reference #1: Minnich DJ., Bryant AS., Dooley A., Cerfolio RJ., Photodynamic laser therapy for lesion in the airway., Ann Thorac Surg., 2010 Jun;89(6):1744. Reference #2: Wood DE. Management of malignant tracheobronchial obstruction. Surg Clin North Am. 2002 Jun;82(3):621-42. Reference #3: Guibert N., Mhanna L., Droneau S., Plat G, Didier A., Mazieres J., Hermant C., J Thorac Dis., 2016 Nov;8(11):3343. DISCLOSURE: The following authors have nothing to disclose: Eunjue Yi, Jae Ho Chung, Sungho Lee, Kwang Taik Kim No Product/Research Disclosure Information

Surgical treatment of lung cancer with extended left pneumonectomy and partial resection of thoracic aorta in the patient with massive hemoptysis – Case report

Severe airway bleeding or massive hemoptysis is a rare condition that carries high mortality. Patients are at risk of life-thretening respiratory compromise due to the airways filling with blood. The main principles in the management of massive hemoptysis are: maintainance of airway patency, localization of the source of bleeding and control of the hemorrhage. Most cases of massive hemoptysis are caused by inflammatory lung diseases such as aspergiloma, tuberculosis and bronchiectasis while a severe bleeding from a malignant lung tumor is a rare find. We present a case of massive hemoptysis in a 60-year old woman, caused by the invasion of lung cancer into the left pulmonary trunk and aorta, which was successfully managed by an extended left pneumonectomy, with the resection of the proximal part of the descending thoracic aorta and interposition of a vascualar graft without extra corporeal circulation. A complete (R0) resection was also achieved.

Early surgery for pulmonary Tuberculosis

Objective: The purpose of our study was to analyze current indications for surgery in tuberculosis and evaluate the outcome of early surgical intervention. Place and duration of study: Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from June 2000 to July 2004. Material & methods: Total number of cases was 132; M: F 105: 27. Age range was 20 to 79 years. Mean age was 48.4 years. The indications for surgical intervention included 5 cases of pulmonary aspergillioma, 9 cases of pneumothorax; 3 cases of pulmonary nodes and masses without histological diagnosis, 15 cases bronchiectasis, 12 cases of massive hemoptysis and 82 cases of pleural empyema while six patients with multi drug-resistant tuberculosis required surgical intervention. Results: The techniques utilized included lobectomy in 45 cases, pleural drainage in 20 cases, segmented pulmonary resection in 32 cases, surgical procedures on the chest wall in 17 cases, pneumonectomy in 10 cases, decortication in 8 cases. In 22 cases two or more procedures were performed on the same patient. In 26(19.6%) cases various complications were noted of which wound infection was the most frequent. There was a mortality rate of 3.3% (4 cases). Conclusion: Surgical treatment is indicated for the complication of TB and management of MDR TB. Early surgery is beneficial in patients whose disease is still localized and who can tolerate resection surgery; of particular importance is a healthy opposite lung, on which the patient would be dependent during and immediately after surgery.

Tracheal Hemangioma: The "Cherry" in the Trachea.

A young adult presented with a four-month long history of hemoptysis. A computed tomography (CT) scan showed a mid-trachea lesion (Figure 1). A flexible bronchoscopy was performed and revealed a cherry-like polyp (Figure 2(a)) and biopsy resulted in brisk bleeding. The polyp was coagulated at the base with a Nd-YAG (neodymium doped-yttrium aluminium garnet) laser followed by forceps resection via the rigid bronchoscope (Video). Histology of the 8 mm by 10 mm lesion was classic of a lobular capillary hemangioma (LCH) (Figure 3). The patient had been asymptomatic since and bronchoscopy performed two years later showed no tumor recurrence (Figure 2(b)). Figure 1 Computed tomography showed a homogeneously contrast enhanced polyp (white arrow) on the left lateral wall of the mid-trachea. Figure 2 (a) Distinct cherry-like polyp consistent with hemangioma arising from the left lateral wall of the mid-trachea depicted on bronchoscopy. (b) Bronchoscopy performed two years later revealed a small scar induration with normal mucosa (arrow) overlaying ... Figure 3 A nodular lesion with squamous metaplasia (marked downwards thick arrow) of the surface epithelium, underlying fibrinous exudates (marked ∗), and a florid proliferation of small capillaries (marked →) surrounded by fibrous stroma on 10x ... Lobular capillary hemangioma (LCH) is typically found on cutaneous and oronasal mucosa. Tracheobronchial LCH is a rarity [1]. Hemoptysis often occurs for a short duration ranging from weeks to months with the exception of one reported case of massive hemoptysis which required arterial embolization. The airway lesion is usually small (<10 mm), sessile, or polypoid with a distinctive glinting vascular (cherry) appearance that bleeds easily. Pathogenesis of this benign tumor is unclear and has been correlated to infections, trauma, and hormonal shifts [1]. The latter can be supported by the case of a rapidly growing trachea LCH (40 mm by 20 mm) found in a pregnant lady who presented with critical airway obstruction [2]. The characteristic findings of a homogeneously contrast enhanced lesion seen on CT scan and an airway lesion (as described above) observed during bronchoscopy should lead to a cautious biopsy to clinch the diagnosis. Bronchoscopic ablative intervention often results in a cure although past reports had a follow-up of one year or less. Ablative modalities included endoscopic resection with Nd-YAG laser, argon plasma coagulation, electrocautery, cryotherapy, and forceps. In one reported case of tumor recurrence, brachytherapy was applied.

Feasibility of computed tomography angiography as an essential prerequisite tool in cases of massive hemoptysis requiring embolization in a tuberculosis prevalent South Indian population: Case series

Aims: The objective of this study is to assess the cases of massive hemoptysis suited for bronchial artery embolization (BAE). The useful role of computed tomography angiography (CTA) in assessing the arteries responsible for the hemoptysis, prior to endovascular imaging and intervention is assessed. Materials and Methods: CTA was performed with a 16 slice multi-detector row computed tomography scanner on all cases of massive hemoptysis provisionally posted for BAE (12 cases) in a 9 month period. Results: Out of the 12 patients, 10 were completely symptom free after 6 months (83% success rate). Out of the 12 cases, 1 was judged as suboptimal detection on the CTA as compared with the conventional angiography. In 11 cases, CTA appropriately demonstrated the hypertrophied bronchials, which were confirmed on conventional angiography and subsequently embolized (sensitivity 92%). All the 11 cases, which demonstrated the bronchial arterial (BA) and non-bronchial arterial feeders were also detected on conventional angiography (specificity 92%). Conclusions: CTA is helpful in identifying the precise origin of the BAs from the aorta, which enhances the success of the procedure and clinical results. We recommend CTA before conventional angiography and attempting BAE.

A Case of Massive Hemoptysis due to Dieulafoy's Disease of the Bronchus

Dieulafoy's disease of the bronchus is rare but potentially life-threatening, and should be considered in patients with massive hemoptysis, especially from unknown etiology. We report a case of a patient with massive hemoptysis due to bronchial Dieulafoy's disease. He underwent bronchial artery embolization and surgical resection, and the post-operative specimen revealed dilated and tortuous arteries in the submucosa that presented as Dieulafoy's disease of the bronchus.

Emergency surgical treatment of hemoptysis

Objective To explore discussion medical treatment in massive hemoptysis emergency surgical treatment.Methods Hemorrhage parts,timing of surgery,pneumonectomy scope in 24 cases of massive hemoptysis were analyzed.Results 24 cases of massive hemoptysis emergency surgical treatment were successful,no death and complication rate was 8.3% (2/24).Conclusion For medical treatment ineffective massive hemoptysis determine the location of the bleeding,actively carry out preoperative preparation, choosing the best opportunity emergency resection of lung disease,can be effective in reducing mortality. Key words: Hemoptysis; Emergcncy treatment; Surgical procedures,operative

The first case report of dental floss pick-related injury presenting with massive hemoptysis: A case report

IntroductionA tracheobronchial foreign body is a rarely mentioned cause of massive hemoptysis. Although an aspirated toothpick is a well-known cause of traumatic injury to the respiratory tract, a similar device called a dental floss pick, which is much larger than a toothpick, has never been described as a tracheobronchial foreign body.Case presentationWe report a case of massive hemoptysis in a 32-year-old man due to a dental floss pick in the left main bronchus. Flexible fiberoptic bronchoscopy was successful in removing the foreign body.ConclusionTracheobronchial foreign body can be a medical emergency requiring immediate intervention and massive hemoptysis may be the presenting symptom. Flexible fiberoptic bronchoscopy is recommended as the first-line treatment modality for tracheobronchial foreign body removal. A dental floss pick may present as a tracheobronchial foreign body and can reside in the airway asymptomatically for many years.

Pulmonary Artery Access Embolization in Patients with Massive Hemoptysis in Whom Bronchial and/or Nonbronchial Systemic Artery Embolization Is Contraindicated

The objective of this paper is to present an alternative therapeutic approach for the treatment of patients with massive hemoptysis in whom bronchial and/or nonbronchial systemic arterial embolization is not possible. We describe a percutaneous procedure for pulmonary segmental artery embolization. Between May 2000 and July 2006, 27 adult patients with hemoptysis underwent percutaneous treatment at our department; 20 of 27 patients were embolized via bronchial and or nonbronchial systemic arteries and 7 patients were embolized via pulmonary artery. Femoral arterial access for systemic artery catheterization and femoral vein access for pulmonary arterial catheterization were used. Gelfoam particles and coils were used for embolization. In this study, we report on three cases of massive hemoptysis from a systemic arterial source in whom bronchial and/or nonbronchial arteries embolization was not possible. Percutaneous embolization via the pulmonary artery access was successful in all three patients. In conclusion, embolization via pulmonary artery is presented as an alternative approach for the management of hemoptysis in patients in whom bronchial arterial embolization is not possible.

A Case of Total Lung Collapse due to Hemoptysis in Pregnancy

Pregnancy induces many physiologic changes, and it can cause hemoptysis in relation to the underlying or potential pulmonary diseases. Although hemoptysis is not a frequent event during pregnancy, a thorough search for its etiology and then immediate management should be initiated for a case of massive hemoptysis to avoid serious adverse effects on both the fetus and the mother. Most hemoptysis events during pregnancy are related to well known etiologies, but there are a few reported cases of hemoptysis in pregnant women who are without any underlying lung lesion. We report here on a case of a pregnant woman with total lung collapse due to hemoptysis, and a thorough search for the etiology after delivery could not reveal any etiology.

A Case of Massive Hemoptysis &amp; Pneumonia Caused by Metallic Foreign Body

저자들은 기관지 내에 이물이 있음을 알고도 장기간 간과하여 이로 인해 대량객혈과, 폐쇄성 폐렴 등이 발생하였고 이물의 자발적인 제거로 임상 증상 및 방사선적인 호전을 보인 증례 1예를 경험하였기에 보고하는 바이다. 또한 증상이 없는 폐 이물질이 우연히 발견된 경우에도 향후 이물질로 인한 합병증 발생의 가능성을 생각해서 제거에 대한 필요성을 환자에게 적극적으로 알릴 필요가 있다는 점을 느낀 증례이다.