Cause Of Hemoptysis Research Articles

Rasmussen's aneurysm: A rare and forgotten cause of hemoptysis

Hemoptysis as a sequelae of past tubercular infection of lungs is a known occurrence. Hemoptysis in such a patient can result from a number of etiologies like tubercular reactivation, bronchiectasis, aspergiloma and vascular complications like hypervascularity from bronchial arteries, arteriovenous fistula formation, pseudoaneurysms, etc. Massive hemoptysis in such a patient is usually treated by bronchial artery embolization and occasionally by surgical lobectomy. A rare source of bleeding in such a patient is from Rasmussen's aneurysm arising from the pulmonary arteries. We report a young patient of treated pulmonary tuberculosis who had recurrent hemoptysis. He was treated earlier with bronchial artery embolization. On recurrence of hemoptysis, he was reevaluated and was found to have multiple Rasmussen's aneurysms arising from the pulmonary arteries, which were successfully treated by coil embolization.

Management von Hämoptysen: Ergebnisse einer algorithmusbasierten interdisziplinären Versorgung

Hemoptysis is a worrying symptom for the majority of patients, is frequently a sign for a severe disease and can develop into a life-threatening situation. Various therapeutic methods and medical specialties can be involved in the management of these patients. Guidelines or evidence-based recommendations on this issue are not available. Based on our long-term experience and considering all established diagnostic and therapeutic means, we propose an algorithm to manage this condition. This is a retrospective analysis of a cohort from a single thoracic surgical institution. Data regarding the used diagnostic and therapeutic methods with focus on outcome parameters are presented. Based on our experience and the published data we discuss the proposed algorithm. Between 01.2009 and 12.2013, 204 patients were hospitalised and treated for hemoptysis. Malignancies were the most frequent (50 %) cause of hemoptysis, followed by infectious/inflammatory diseases (25 %), cardiovascular disorders (6 %), rare (12 %) and unclear (7 %) circumstances. In 71 cases the bleeding stopped spontaneously, in 124 (61 %) one invasive measure (interventional bronchoscopy 43, bronchial artery embolisation 34 or operation 12) or a combination of methods (35 combinations of two or all three methods) were necessary to stop the hemoptysis. Six patients died without intervention. The bronchial artery embolisation showed a 79 % success rate and a morbidity of 11 %. Lung resections were performed in 30 cases (morbidity 43 %, mortality 0 %). The mortality directly due to massive hemoptysis was 4.5 %. Even small hemoptysis can be the warning signal for serious conditions and immediate diagnostic evaluation and therapy, preferentially in an inpatient setting, is often mandatory. A prompt diagnostic bronchoscopy is advocated. The therapeutic method of first choice is non-surgical for the most cases (interventional bronchoscopy, bronchial artery embolisation). Lung resections retain an important role in the management of hemoptysis and are the only available therapy for some diseases. It is advisable to delay surgery until the bleeding is controlled and the patient is stabilised. Best results for managing hemoptysis can be achieved with a multidisciplinary approach (interventional bronchoscopy, angiology and thoracic surgery) in a high expertise centre.

Extended-Thoracic Imaging of Multi-slice Computed Tomography Technique in the Evaluation of Hemoptysis Resulting from Neoplastic Lesions: Two Cases Study

Objective: This study aimed to evaluate the role of multi-detectors computed tomography in patients suffering from hemoptysis, resulting from neoplastic lesions, and aiming to reach proper diagnosis and subsequent proper management. Methods: This study was carried out on consecutive 13 patients suffering from hemoptysis resulting from malignant thoracic lesions. All patients were subject to complete clinical assessment, laboratory study, roentgen graphic study including Plain chest X-Ray and Multidetector Computed Tomography (MDCT), Multidetector Computed Tomography Angiography (MDCTA), Minimum intensity projection (MIP), 3D volume –rendering images and Virtual Bronchoscopy (VB). VB was also compared with the report of Fiber-optic Bronchoscopy (FOB). Conventional Angiography was performed in selected indicated patients with a digital subtraction technique (DSA). (2 patients only). Results: 9 male (70%), and 4 female (30%). Based on clinical chest X-RAY, MDCT, DSA , FOB and Histopathology , a source and etiology for bleeding could be identified applying a diagnostic work up in 12 /13 (92%). Plain radiography was considered successfully contributing in the identification of the cause of hemoptysis in only 38.5% of patients. CT angiography showed enlarged tortuous bronchial feeding vessels in 42% of patients. Bleeding from pulmonary artery was identified in 20%. DSA was performed in 2 patients 15%, indicated for embolization. Fibrooptic bronchoscopy findings were evaluated in 13/13 patients with histopathological confirmation in 12 patients. Conclusion: The study concluded that MDCT using VB is considered a primary non-invasive imaging modality in the evaluation of patients with hemoptysis resulting from neoplastic lesions.

Evidenced-based management of haemoptysis by otolaryngologists.

Haemoptysis is an uncommon presenting symptom to the ENT clinic and ward, but has potentially sinister aetiology. This article aims to provide a systematic and evidence-based method of managing patients with haemoptysis. The data in this article are based on a literature search performed using PubMed in August 2013. The keywords used included 'haemoptysis' in combination with 'otolaryngology', 'ENT', 'head & neck', 'diagnosis', 'management', 'investigations' and 'treatment'. The majority of published literature on the subject is level IV evidence. However, this can guide ENT specialists in assessing, investigating and managing presentations of haemoptysis. Understanding the different causes of haemoptysis is important for the otolaryngologist. The main concern is the detection of a malignant lesion in the upper aerodigestive tract or tracheobronchial tree. A thorough history and systematic examination can aid diagnosis.

MULTIDETECTOR-ROW COMPUTED TOMOGRAPHY PATTERNS OF BRONCHOESPHAGEAL ARTERY HYPERTROPHY AND SYSTEMIC-TO-PULMONARY FISTULA IN DOGS.

Anomalies involving arterial branches in the lungs are one of the causes of hemoptysis in humans and dogs. Congenital and acquired patterns of bronchoesophageal artery hypertrophy have been reported in humans based on CT characteristics. The purpose of this retrospective study was to describe clinical, echocardiographic, and multidetector computed tomography features of bronchoesophageal artery hypertrophy and systemic-to-pulmonary arterial communications in a sample of 14 dogs. Two main vascular patterns were identified in dogs that resembled congenital and acquired conditions reported in humans. Pattern 1 appeared as an aberrant origin of the right bronchoesophageal artery, normal origin of the left one, and enlargement of both the bronchial and esophageal branches that formed a dense network terminating in a pulmonary artery through an orifice. Pattern 2 appeared as a normal origin of both right and left bronchoesophageal arteries, with an enlarged and tortuous course along the bronchi to the periphery of the lung, where they communicated with subsegmental pulmonary arteries. Dogs having Pattern 1 also had paraesophageal and esophageal varices, with the latter being confirmed by videoendoscopy examination. Authors conclude that dogs with Pattern 1 should be differentiated from dogs with other congenital vascular systemic-to-pulmonary connections. Dogs having Pattern 2 should be evaluated for underlying pleural or pulmonary diseases. Bronchoesophageal artery hypertrophy can be accompanied by esophageal venous engorgement and should be included in the differential diagnosis for esophageal and paraesophageal varices in dogs.

Idiopathic Pulmonary Vein Thrombosis: A Rare Presentation of Recurrent Haemoptysis

Idiopathic pulmonary vein thrombosis, as a cause of haemoptysis, is a rare entity published in very few medical literatures. It may mimic various other clinical conditions but has a different investigation strategy and prognosis. Pulmonary vein thrombosis is difficult to diagnose clinically, requires a high degree of suspicion and a combination of conventionally used diagnostic modalities and hence very few cases have been reported worldwide. Ours is a case of a healthy adult who presented with massive haemoptysis and was diagnosed as having idiopathic pulmonary vein thrombosis with secondary pulmonary infarction. The pulmonary veins got reanalysed spontaneously within a month of presentation and his symptoms subsided.

Bronchial artery embolization in chronic pulmonary thromboembolism: A therapeutic dilemma

Bronchial artery embolization is the treatment of choice for the management of life-threatening massive hemoptysis. Chronic pulmonary thromboembolism (PTE) is one of the rare causes of hemoptysis. Management of hemoptysis in chronic PTE is a point of debate. In this article, we have reported one case of hemoptysis in chronic PTE managed successfully with bronchial artery embolization.

Pulmonary actinomycosis masquerading as a malignant lung tumor

Pulmonary actinomycosis being a rare disease is an important and challenging diagnosis to make. The disease is commonly confused with conditions such as chronic suppurative lung diseases and malignancy thus requiring a high index of suspicion. Considerable psychological and physical morbidity, including unwarranted surgery can be prevented with an early and accurate diagnosis. We hereby present a case of 60-year-old male who presented to a tertiary care hospital with the chief complaint of hemoptysis and chest pain. On evaluating for the cause of hemoptysis, the clinical and radiologic findings were suggestive of lung cancer. The diagnosis of actinomycosis was determined by computed tomography guided transthoracic lung biopsy. Respiratory physicians should be aware of this important differential when investigating patients for persistent pulmonary shadowing.

A rare cause of hemoptysis. orthotopic or ectopic bronchial artery? A brief review of the literature.

Normal bronsial arterler direkt olarak inen torasik aortadan koken alan ve havayollari, ozefagus ve lenf nodalarinin beslenmesini saglayan kucuk capli damarlardir. Bronsial arterler orjinlerine, dallanma paternlerine ve seyirlerine gore farkli anatomik varyasyonlar gosterebilirler.Anormal yerlesimli bir bronsial arterin en onemli komplikasyonu ruptur ve hemoptizidir. Bu tip hastalarin tedavisi icin akcigerin anormal vaskuler yapilarinin anlasilmasi onem arz etmektedir.

Common origin for the innominate and left common carotid arteries: A pattern of human aortic branching epicted on multidetector CT

Most anomalies of the aortic arch arise due to the persistence of its parts that normally disappear, or due to the disapperance of parts that normally persist. We report a variant of aortic arch branching found on chest computerized tomography in a 75-year old Serbian man who had recurrent hemoptysis and an abnormal chest radiograph representing marked widening of the right superior mediastinum. Computerized tomography revealed a shared origin of the innominate and left common carotid arteries was found. This finding excluded tumor or pulmonary embolism as a cause of hemoptysis. The reason for hempotysis was anticoagulant therapy which patient had been receiving because of cardiovascula disease. We discuss the relative literature and underline the clinical impact of such a variation.

Systemic to pulmonary arteriovenous fistula in a patient with tuberculosis sequels: A sign of inflammatory neoangiogenesis

Introduction: the study of the causes of hemoptysis entails multiple diagnostic choices and tests. However, in 30% of the cases, a cause is not clearly identified (cryptogenic hemoptysis). Even though pulmonary arteriovenous malformations are uncommon, they must be taken into account as possible causes of hemoptysis. Particularly, acquired systemic-to-pulmonary vascular fistulas are atypical and represent both diagnostic and

Diagnostic Yield of Bronchial Washing Fluid Analysis for Hemoptysis in Patients with Bronchiectasis

PurposeBronchiectasis is the main cause of hemoptysis. When patients with bronchiectasis develop hemoptysis, clinicians often perform bronchoscopy and bronchial washing to obtain samples for microbiological and cytological examinations. Bronchial washing fluids were analyzed from patients with bronchiectasis who developed hemoptysis, and the clinical impacts of these analyses were examined.Materials and MethodsA retrospective observational study of patients who underwent fiberoptic bronchoscopy for hemoptysis in Seoul National University Bundang Hospital, a university affiliated tertiary referral hospital, between January 2006 and December 2010 were reviewed. Among them, patients who had bronchiectasis confirmed by computed tomography and had no definite cause of hemoptysis other than bronchiectasis were reviewed. The demographic characteristics, bronchoscopy findings, microbiological data, pathology results and clinical courses of these patients were retrospectively reviewed.ResultsA total of 130 patients were reviewed. Bacteria, non-tuberculous mycobacteria (NTM), and Mycobacterium tuberculosis were isolated from bronchial washing fluids of 29.5%, 21.3%, and 0.8% patients, respectively. Suspected causal bacteria were isolated only from bronchial washing fluid in 19 patients, but this analysis led to antibiotics change in only one patient. Of the 27 patients in whom NTM were isolated from bronchial washing fluid, none of these patients took anti-NTM medication during the median follow-up period of 505 days. Malignant cells were not identified in none of the patients.ConclusionBronchial washing is a useful method to identify microorganisms when patients with bronchiectasis develop hemoptysis. However, these results only minimally affect clinical decisions.

Percutaneous Transcatheter Embolization of Pulmonary Artery Pseudoaneurysms Causing Massive Hemoptysis

Systemic bronchial arterial circulation is the most common source for massive hemoptysis. Rarely, the source of bleeding can be the pulmonary artery. We report 2 different case scenarios of massive hemoptysis due to different etiologies, in which the source of bleeding was the pulmonary artery. Both the patients were treated with percutaneous transcatheter embolotherapy using coils. The 2 cases highlight the importance of considering pulmonary arterial etiology as the cause of hemoptysis while reporting diagnostic computed tomography studies and tailoring the interventional technique toward performing pulmonary angiography instead of searching for a systemic arterial source for hemoptysis.

Bronchial Artery Embolization in Life-Threatening Massive Hemoptysis

BackgroundMassive hemoptysis is a potentially life threatening respiratory emergency and mandates immediate investigation and intervention. There is no universal consensus regarding the optimal management of these patients, and there are no large series of patients studied.ObjectivesHere we reported thirty Iranian patients who were managed with bronchial artery embolization.Patients and MethodsAll the patients had already been assessed by computerized tomography (CT) to localize and delineate the underlying etiology except 2 patients who had not undergone CT scan.ResultsTuberculosis, bronchiectasis, and lung cancer/metastasis were the most common causes, detected in 14(47%), 5(17%) and 4(13%) patients respectively. Other causes of hemoptysis including chronic bronchitis, interlobar artery aneurysm, hydatid cyst, arteriovenous fistula, pulmonary embolism, and exposure to chemical weapons each detected in one patient separately. All of them had abnormal chest CT scans, except for 2 patients who had not undergone CT scan (one with hydatid cyst and another with bronchial tumor diagnosed with bronchoscopy). Bleeding location which has been confirmed with angiography could be predicted with CT scan among 7 of 14 patients with TB, (sensitivity=50%). While this rate was 100% among all other patients with other diagnosis who had undergone CT scan.ConclusionsIn conclusion complementary to the previous studies our results have demonstrated that bronchial artery embolization remains as one of the most efficient procedures in managing massive hemoptysis, with minimal rate of complications.

Percutaneous transcatheter vascular embolization for life threatening hemoptysis

The aim of this study was to retrospectively evaluate 47 patients (37 males and 10 females, aged 37–72years) with life threatening hemoptysis treated by bronchial artery embolization. Between April 2007 and April 2012 at the Assuit University Hospital, the cause of hemoptysis was tuberculosis and post TB bronchiectasis in 29 patients, bronchiectasis in 11, 3 arteriovenous malformation, 3 post infective fibrosis and one patient with chronic renal failure. Recurrence of hemoptysis after embolization occurred in 2 patients within the 6month follow-up period, these cases underwent re-embolization with successful control of hemoptysis. There were no procedure-related major complications. Bronchial artery embolization is a safe and effective palliative treatment for patients with massive hemoptysis.

Hemoptysis: A Prospective Analysis of 110 Cases

Background: Hemoptysis is one of the commonest manifestations of the various underlying disease. A major problem in managing hemoptysis is the wider spectrum of causative factors. The effective management of hemoptysis depends upon identification of the etiology and localization of the site of bleeding. Objective: The objective of present study was to validate the relative frequency of different causes of hemoptysis and to identify its various risk factors. Methods: This 2-year prospective study was carried out on 110 patients presenting with hemoptysis. Routine blood investigations and chest radiographs were done for all patients. Bronchoscopy and HRCT chest was done for selected patients. Results obtained were evaluated. Results: Male to Female ratio was found to be 2.23:1. A total of 73.63% (n=81) of patients were admitted for the first episode of hemoptysis and 26.36% (n=29) for recurrent hemoptysis. Bronchiectasis was found to be the most common cause of hemoptysis in 34.55% patients, followed by old tubercular lesions in 26.36% of patients. History of blood stained sputum was given by 59 (53.64%) patients, frank hemoptysis was reported by 33 (30%) patients, and 18 (16.36%) patients gave the history of hemoptysis. Conclusion: Even one episode of hemoptysis should not be ignored and investigated properly. Bronchiectasis was the most common cause of hemoptysis in followed by old tubercular lesions.

Diagnostik und Behandlungskonzept bei Hämoptoe

Haemoptysis is defined as the expectoration of blood or bloody streaking of the sputum. The list of possible underlying differential diagnoses is broad, and the cause of haemoptysis depends on the origin of the individual patient. Patients with minor haemoptysis can often be managed in the outpatient setting. In contrast, patients with major haemoptysis require immediate in-hospital diagnostic workup and therapy. Patients with major haemoptysis should be managed by a multidisciplinary team consisting of Pulmonologists, Critical Care Physicians/Anaesthesiologists, Interventional Radiologists, and Thoracic Surgeons. In major haemoptysis, airway maintenance, adequate gas exchange, and haemodynamic stabilization are mandatory. In this article, the recommended diagnostic and therapeutic steps in patients with major haemoptysis (particularly computed tomography, laboratory analyses, bronchoscopy, and bronchial artery embolization) are presented and discussed.

Mimicry of sugar tumor and minute pulmonary meningothelial-like nodule to metastatic lung deposits in a patient with rectal adenocarcinoma

Several reports have described different lung lesions mimicking primary or metastatic neoplasms. In this paper, we describe the different features of two uncommon and benign lung lesions mimicking metastasis from a primary large bowel adenocarcinoma. Our patient is a 75-year old female with a history of invasive rectal adenocarcinoma. One month after her surgery, she started complaining of coughing and shortness of breath. Clear cell sugar tumor and minute meningothelial-like nodules had been found incidentally and simultaneously during her chest x-ray. The diagnosis had been made based on morphology and was supported by a positive staining to a panel of immunohistochemical stains including CD34, vimentin, HMB45, melan A and S100. An ultra-structural examination was also performed and confirmed the presence of melanosomes in sugar tumor. The coexistence of lung sugar tumor and minute pulmonary meningothelial-like nodules has never been reported in the literature and an awareness of these lesions is essential to correctly diagnose and stage patients.

An unusual cause of haemoptysis in a smoker

A 33-year-old Caucasian male smoker presented to our rapid access lung cancer clinic with a single episode of moderate haemoptysis and no other respiratory or systemic symptoms. There was no...

Trepopnea Due to Amiodarone-Induced Diffuse Alveolar Hemorrhage

Diffuse hemorrhage is a known but infrequent complication of amiodarone pulmonary toxicity and a cause of hemoptysis, with 12 cases reported up to now. Unlike other form of amiodarone pulmonary toxicity, early or very early[1][1] onset seems to be common. It is thought to be mistaken for acute heart