Cause Of Hemoptysis Research Articles

Differential diagnosis of hemoptysis

Blood expectoration or hemoptysis is the coughing up of sputum with blood from the larynx, bronchi or lungs. Hemoptysis is most often caused by diseases of the respiratory tract and lungs — bronchitis or pneumonia, as well as lung cancer, aspergilloma, tuberculosis, bronchiectasis, pulmonary embolism, etc. In the diagnostic investigation of the cause of hemoptysis, it is important to take a detailed history (in the case of an epidemiological history, a laboratory analysis of the secreted sputum for the detection of the causative agent of an infectious disease is necessary), to make the correct interpretation of the patient’s complaints and an assessment of the nature of the sputum (differential diagnosis with bleeding from the upper gastrointestinal tract). A chest X-ray is performed and, then, if indicated, computed tomography, bronchoscopy, and other studies are made. The article presents an algorithm for differential diagnostic investigation of hemoptysis in a patient

A CROSS-SECTIONAL STUDY TO EVALUATE THE ETIOLOGICAL PROFILE OF HEMOPTYSIS AND IT’S CORRELATION WITH SEVERITY

Introduction:- Hemoptysis is the spitting of blood that originated in the lungs or bronchial tubes.The patient's history should help determine the amount of blood and a focused physical examination can lead to the diagnosis in most cases. Chest radiographs often aid in diagnosis and assist in using two complementary diagnostic procedures, fiberoptic bronchoscopy and high-resolution computed tomography, which are useful in difficult cases and when malignancy is suspected. Materials and Methods: -We prospectively evaluated 100 patients with hemoptysis,aged ≥18 years,presented in our hospital during 1-year study period. After applying inclusion and exclusion criteria, study population was selected. Patient underwent thorough clinical,general and respiratory examination.Initial routine blood,sputum and radiological evaluation was done in form of chest radiographs. Further chest computed tomography (CT) and bronchoscopic evaluation was done to find the etiology in cases diagnosis was not confirmed in chest radiograph. Final diagnosis was made, and association is seen between various demographic characteristics, comorbidities, severity of hemoptysis, radiological findings and diagnostic yield of different modalities was made. Results:- Tuberculosis was found to be the most common etiology (39%), followed by bronchogenic carcinoma(14%) and bronchiectasis (13%). The majority of the cases had mild (48%) and moderate (39%) hemoptysis with a small proportion of patients (13%) with severe hemoptysis.The diagnostic yield of CT Chest was 73%,that of FOB was 69.5% and the combined yield using both the modalities was calculated to be 82.6%. Conclusion:- Pulmonary tuberculosis remains a leading cause of hemoptysis because of high prevalence but still it is an alarming symptom and require thorough workup to find out the exact etiology.The combined use of bronchoscopy and chest CT probably gives the best diagnostic yield.

Abstract No. 48 Usefulness of cone-beam computed tomography during bronchial artery embolization

Bronchial artery embolization (BAE) is a well-established intervention for treating benign and malignant causes of hemoptysis with high success rate from 70-99%; a subset of these procedures involve bronchial artery chemoperfusion, which has been used in palliation of lung malignancies. One of the dreaded complications of BAE is non-target embolization resulting in spinal cord ischemia, occurring in 0.6-4.4% of patients. This study aims to examine whether the adjunct use of CBCT with digital subtraction angiography (DSA) has an impact on BAE interventions. Twenty-one (10M, 11F) patients of mean age 55.5 who underwent DSA with CBCT prior to BAE from 2010 to 2020 were evaluated for single-institutional retrospective study. Retrospective analysis of the dictated reports were performed in conjunction with the available stored images and findings were summarized into 3 categories: 1) CBCT added no benefit; 2) CBCT added benefit (i.e., increased diagnostic confidence) without change in procedural management; 3) CBCT added benefit with change in intraprocedural management. The frequency and percentage of each category were calculated. 14/21 patients (66.7%) (95% CI: 0.47-0.87) were placed into category 2 whereby CBCT increased diagnostic confidence for embolization. The remaining 7/21 (33.3%) patients (95% CI: 0.13-0.53) were placed into category 3. In 3 of these patients, CBCT resulted in microcatheter repositioning to a selective bronchial artery branch to avoid nontarget embolization of a spinal artery. In 2 patients, CBCT confirmed normal tissue perfusion resulting in microcatheter repositioning to find an alternate source. In the remaining 2 patients, CBCT showed additional intercostal collaterals to ipsilateral bronchial arteries, which were then embolized. No cases were placed into category 1. One patient (4.8%) had a complication of spinal cord ischemia likely related to non-target embolization via small posterior radiculomedullary arterial branches, which in retrospect were seen on CBCT but not DSA. No other complications were seen. Adjunct use of CBCT during BAE provides additional information beyond DSA. This resulted in increased diagnostic confidence 67% of the time and in 33% of cases resulted in intraprocedural change in management, often to avoid non-target embolization via DSA-occult spinal arteries.

The Effectiveness of Gelfoam as the Sole and Primary Embolization Agent in the Management of Hemoptysis: A Retrospective Study from a Tertiary Care Center.

Objectives:The objective of this study was to evaluate the role of Gelfoam as an effective embolizing agent in patients with hemoptysis presenting to a tertiary care center in developing nations.Material and Methods:A retrospective analysis of data from 30 patients treated by Interventional radiologist at St. John’s Medical College, Bangalore, India, was performed. The study included 22 males (73.3%) and 8 (26.65%) female patients. Gelfoam was used as the sole embolizing agent and arteries with features of abnormal blush and hypertrophy were targeted. Analysis of the etiology, immediate, and short-term outcome and complications, when present, was performed. The median follow-up period was 45 days following an embolization procedure at this center.Results:A high short-term efficacy was noted following embolization procedures with Gelfoam as the sole agent. Twenty-eight out of 30 procedures were deemed successful, and post-tubercular changes were noted to be the cause for hemoptysis in 23 patients. The high short-term efficacy (93.3%), evidenced by a complete stoppage of hemoptysis, along with a relatively low rate of complications (spinal cord ischemia in only 2.3%), strengthens the position of Gelfoam as the sole embolizing agent in a resource-limited setting.Conclusion:In an economically constrained setting, Gelfoam proves to be a useful first choice single embolization agent, while polyvinyl alcohol particles coupled with microcatheter systems remain within reach of only those who can afford them.

A rare cause of hemoptysis in patient with chronic kidney disease: pseudoaneurysm of pulmonary vein related to lung malignancy

Hemoptysis is a common presentation of underlying pulmonary or bronchial artery aneurysm. Amongst the causes of non-life-threatening hemoptysis are old healed pulmonary Koch’s, aspergilloma, bronchogenic carcinoma, blunt or penetrating trauma. Pseudoaneurysm of pulmonary vein has not been reported in the literature as a cause of hemoptysis in nontraumatic patients. A very rare case of pulmonary vein pseudoaneurysm as a cause of hemoptysis in patient with lung malignancy along with chronic kidney disease is presented in current report.

Clinical characteristics and aetiologicalanalysis of 133 patients for pulmonary embolism combined with haemoptysis.

In the patients with pulmonary embolism (PE), PE itself can cause haemoptysis and other reasons can also cause haemoptysis. Therefore, the clinicalcharacteristics and the causes of haemoptysis are lacking. A retrospectiveanalysiswas performed that involved screening 583 PE patients and determining that haemoptysis occurred in 141 cases. Of these, eight cases were omitted due to anticoagulation-related haemoptysis or unavailable data, leaving 133 cases that were enrolled in final analysis (127 acute and 6 chronic case of PE). We classified the acute PE patients who combined with diseases which can cause haemoptysis to non-simple group (n =61) and those without these diseases to simple group (n =66). The incidence of haemoptysis in PE patients was 23.75%. In the simple group, the amount of haemoptysis ≤ 5 mL was 80.30% (53/66) and ≤ 20 mL was 90.91% (60/66). In the non-simple group who combined with lung cancer, the amount of haemoptysis ≤ 5 mL was 68.4% (26/38) and ≤ 20 mL was 86.8% (33/38). Further analyses revealed that the amount of haemoptysis in the non-simple group was larger than that in the simple group (median 5 [5-125] vs. 5 [5-5], p < 0.001; volume ≥ 100 mL: 29.5% vs. 6.1%, p< 0.001). Among all the PE patients, chronic thromboembolic pulmonary hypertension (CTEPH), PE combined with tuberculosis (TB) and PE combined with bronchiectasis were independent risk factors for the amount of haemoptysis ≥ 100 mL (OR =15.00, (95% CI: 2.235-100.652); 12.00, (3.101-46.437); 60.00, (6.552-549.441), respectively). The haemoptysis caused by acutePE or PE combined with lung cancer was mild and was characterised by blood in sputum. PE combinedwith TB, bronchiectasis and CTEPH are associated with moderate to massive haemoptysis, with a greater risk of haemoptysis ≥ 100 mL.

Bronchial Dieulafoy Lesion Embolization with Onyx: a Case Report

Bronchial Dieulafoy lesion (BDL) is a rare cause of hemoptysis that is difficult to diagnose. Identification is critical since treatment is challenging and biopsy can be fatal. Treatment options include bronchial artery embolization (BAE), bronchoscopy intervention, and surgery. BAE is first-line treatment, but success rates are currently between 40 and 53%. This case report describes the use of Onyx for treatment of a BDL after multiple failed particle embolizations. BAE with Onyx offers advantages over other embolization techniques and should be considered for use in treatment of BDL.

Bloody tricuspid stenosis: case report of an uncommon cause of haemoptysis.

BackgroundHaemoptysis is usually caused by pulmonary and infectious diseases. In few cases, it has a cardiac cause, such as pulmonary embolism or mitral valve stenosis. Haemoptysis may be an uncommon symptom of prosthetic valve dysfunction, being related to elevated right heart pressures.Case summaryA 22-year-old woman from sub-Saharan Africa known for a triple valve replacement was hospitalized for dyspnoea and haemoptysis. A careful clinical evaluation excluded the most common causes of haemoptysis. Transthoracic echocardiogram showed normal biventricular function, normally functioning mechanical prosthetic aortic and mitral valves, and the biological tricuspid prosthesis showed an increased transvalvular gradient. Contrast chest computed tomography scan excluded pulmonary embolism and mechanical valve obstruction, but revealed marked systemic venous hypertension. Right heart catheterization confirmed increased right heart pressures and severe bioprosthetic tricuspid valve stenosis. The patient underwent a successful percutaneous tricuspid valve-in-valve replacement, with complete resolution of symptoms.DiscussionThe increase in venous pressures due to bioprosthetic tricuspid stenosis caused veno-venous shunts: blood from the lower body was drained into the superior vena cava via the azygos vein. Increased pressure in the latter affected pressure in bronchial veins and arteries, leading to haemoptysis. Cardiac surgical reinterventions are associated with worse outcomes and higher mortality rates. Management of a degenerated prosthetic tricuspid valve is challenging and requires a multidisciplinary assessment. Transcatheter tricuspid valve replacement is becoming a feasible option in patients with prosthetic dysfunction. Based on evidence to date, tricuspid valve-in-valve replacement appears to be a safe, feasible, and effective alternative in selected young patients.

気管支拡張症の炎症によって肺動脈瘤破裂を来した1救命例(Ruptured pulmonary artery aneurysm with bronchiectasis: a case report)

要旨肺動脈瘤は様々な要因により形成され，破裂すると喀血から気道緊急を起こし得る。肺動脈瘤は稀な疾患であり，末梢性と中枢性に分類されるが末梢性肺動脈瘤はさらに頻度が少ない。今回，気管支拡張症の炎症を原因とした末梢性肺動脈瘤破裂の救命例を経験したので報告する。肺炎・気管支拡張症で入院歴のある65歳の男性。自宅で大量喀血し当院救命救急センターに救急搬送となった。造影CT検査で左肺動脈舌区枝（A5）に径25mmの末梢性動脈瘤を認め，喀血の原因と判断された。喀血による気道緊急予防のため，気管支鏡を用いて透視下で責任気管支に気管支ブロッカーを留置したうえで経皮的動脈塞栓術を施行した。肺動脈へカテーテルを進め，血管内バルーンを用いて動脈瘤近傍の血流をコントロールすることで流入および流出血管を確認し，コイル塞栓術を施行した。術後の気管支鏡検査で気管支ブロッカーが気管内出血を制御していることを確認し，責任気管支の血餅除去を行った。術後の造影CT検査では仮性動脈瘤の血栓化が確認され，独歩自宅退院となった。気管支拡張症に肺動脈瘤を合併することは稀であるが，鑑別疾患として考慮する必要がある。また，喀血に対して気管支ブロッカーを用いて出血を制御することは気道緊急を回避する観点から有用と思われる。

Pulmonary mucinous cystic neoplasm from rare causes of hemoptysis

Pulmonary mucinous cystic neoplasm from rare causes of hemoptysis

Hemoptysis in Renal Transplant Recipients.

Background:Hemoptysis is the expectoration of blood from respiratory system. Clinical entities associated with hemoptysis in renal transplant recipients differ from those causing hemoptysis in common population. This review summarizes all reported clinical conditions related to hemoptysis in renal transplant patients, their causes, diagnostic approach and management. Methods and Materials:Primary literature was researched through MEDLINE/PubMed database and Google Scholar without restrictions. Relevant and current literatures related to hemoptysis in renal transplant recipients were used. Results:Overall 23 articles were included, since they report clinical conditions associated with hemoptysis in renal transplant recipients. Opportunistic lung infections, pulmonary hemorrhage associated with drugs and malignancies are usual causes of hemoptysis in these patients, sometimes with a fatal outcome.Conclusions:Hemoptysis is an important manifestation in renal transplant patients, caused frequently by rare clinical entities, different from those in common population.

Flexible Fiberoptic Bronchoscopy: Indications, Diagnostic Yield and Complications.

ObjectiveFlexible fiberoptic bronchoscopy (FFB) has become an essential procedure for diagnosing and managing various respiratory conditions. We aimed to assess the main indications, diagnostic yield, and safety of FFB in our institute.MethodsA total of 216 patients who underwent FFB between July 2009 and June 2012 at King Abdul-Aziz Medical City, Jeddah, Saudi Arabia, were reviewed retrospectively. Indications of the procedure, the diagnostic yield of variable respiratory diseases, and complications were reported.ResultOut of 216 patients, 210 (97.2%) completed FFB. One hundred and ninety-eight (91.7%) bronchoscopies were for diagnostic purposes, and the remaining 12 (5.6%) were for therapeutic aim. The mean age of patients was 50 years ± 20 years and patients. Respiratory infection, malignancy, pulmonary infiltrate in febrile neutropenia (FN), and hemoptysis in order of frequency were the main indications. The overall diagnostic yield was 46%. Mycobacterium tuberculosis (MTB) was the most common indication (26.8%) and was identified in 37.7%, whereas pneumonia was confirmed in 46.3% of the patients. Malignancy was established in 35.3% of suspected cases, while eosinophilic pneumonia was diagnosed in 100%. The diagnostic yield in pulmonary infiltrates of human immunodeficiency viral (HIV) was 85.7%. Alveolar hemorrhage was the most common cause of hemoptysis. Out of therapeutic bronchoscopy, lung collapse was the main indication. There is no mortality and complications occurred in 1.5% of the cases.ConclusionMTB was the most common indication of FFB, followed by malignancy. It has a high diagnostic yield in eosinophilic pneumonia and pulmonary infiltrates in HIV patients. FFB is shown to be a safe modality for diagnostic and therapeutic purposes.

Study of Hemoptysis in a Tertiary Care Center of Province 1: Causes and Recurrences

Introduction: Hemoptysis is a common but distressing and alarming symptom in a patient. Data related to detail clinical profile and follow up study of hemoptysis are lacking.&#x0D; Objective: This study was carried out to see the clinical profile of patients with hemoptysis and to study the recurrences in tertiary care centre of province 1 within the study period.&#x0D; Methodology: This was a prospective observational study conducted at the department of Pulmonary, Critical Care and Sleep Medicine of Nobel Medical College and Teaching Hospital, Biratnagar, Nepal. The study was carried out between 30th January 2017 to 1st February 2020. For follow up of recurrences of hemoptysis, the patients were asked for regular chest clinic follow up and regular telephone calls made to the patients, in case, patients could not attend the chest clinic for any reason.&#x0D; Results: A total of 150 patients were enrolled over the last 3 years. Among them 75% were male. The maximum number of patients (27%) were between 31-40 years of age group. Old sequelae of pulmonary tuberculosis (PTB) (32%) and bronchiectasis (28%) were the commonest cause of hemoptysis. Lung cancer (10%) and active PTB (10%) were other causes of hemoptysis. CT scan of the chest provided the highest (84%) diagnostic yield. Most of the cases were having mild hemoptysis (50%). 17% of the patients in our study had recurrences of hemoptysis.&#x0D; Conclusion: Old PTB sequelae with bronchiectasis (fibrobronchiectasis) were the commonest cause of hemoptysis. Conservative management worked most effectively in controlling hemoptysis, if used properly.

ANOTHER BLOODY PNEUMONIA? PULMONARY HEMORRHAGE DUE TO LARGE PSEUDOANEURYSM WITH AORTOBRONCHIAL FISTULA

SESSION TITLE: Medical Student/Resident Cardiothoracic Surgery Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Aortic pseudoaneurysms are a rare complication of prior vascular or valvular surgery with high mortality. A pseudoaneurysm is a disruption in the blood vessel allowing blood to flow between the tunica media and adventitia. We present a case of an aortic pseudoaneurysm secondary to previous carotid-subclavian bypass presenting as pulmonary hemorrhage. CASE PRESENTATION: A 57-year-old male with a history of carotid-subclavian bypass and recent pulmonary embolism on apixaban presented with hemoptysis. Chest xray showed a left upper lobe mass with consideration for necrotizing pneumonia. Antibiotics were started, however sputum cultures were unrevealing. Then, CT chest revealed an aortic pseudoaneurysm adjacent to a large consolidation that was concerning for malignancy, but follow up PET scan was inconclusive. The patient was discharged home to have further outpatient malignancy workup, but returned within a month for continued hemoptysis. CT aortic dissection protocol revealed a partially thrombosed pseudoaneurysm with aortobronchial fistula. Cardiology evaluated the patient and recommended novel occlusion of pseudoaneursym with duct occluder device given patient’s continued deterioration. The patient was transferred to a quaternary care center for urgent thoracic endovascular aortic repair (TEVAR). DISCUSSION: Hemoptysis is a common presenting complaint typically caused by viral bronchitis, pneumonia, or malignancy. However, rare causes of hemoptysis including aortic pseudoaneurysm should be considered in patients with prior history of cardiothoracic surgery. Pseudoaneurysms typically remain asymptomatic and present late, which leads to high mortality. Most pseudoaneurysms require urgent TEVAR with proposed long-term prophylactic antibiotics to prevent graft infection. Interestingly, in a patient with prohibitively high surgical risk, the pseudoaneurysm can be percutaneously closed with duct occluder devices typically used to close patent foramen ovale and patient ductus arteriosus. CONCLUSIONS: Maintaining a wide differential and pursuing further evaluation in the setting of a declining patient is imperative to determine the appropriate treatment. Rarely, hemoptysis can be caused by aortic pseudoaneurysm and should be considered in the differential of patients with a history of cardiothoracic surgery. Reference #1: Fontana, M., Tonelli, R., Gozzi, F. et al. An uncommon cause of hemoptysis: aortobronchial fistula. Multidiscip Respir Med 13, 25 (2018). https://doi.org/10.1186/s40248-018-0146-3 Reference #2: MacIntosh EL, Parrott JCW, Unruh HW. Fistulas between the aorta and tracheobronchial tree. Ann Thorac Surg. 1991;51:515e9. DISCLOSURES: No relevant relationships by Anas Ahmed, source=Web Response No relevant relationships by Joy Wang, source=Web Response No relevant relationships by Steven Young, source=Web Response

EP08 A case of granulomatosis with polyangiitis complicated by COVID-19: challenges in diagnosis and management

EP08 A case of granulomatosis with polyangiitis complicated by COVID-19: challenges in diagnosis and management

AN UNEXPECTED CAUSE OF HEMOPTYSIS: RARE TRACHEAL TUMOR

SESSION TITLE: Fellows Lung Cancer Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Leading causes of hemoptysis in the western world are cryptogenic and infectious. We present a case of a young adult with isolated hemoptysis subsequently found to have a rare tracheal tumor. CASE PRESENTATION: A 24 yo male presented to the emergency room with hemoptysis of 3-4 tablespoons of bright red blood. He is a competitive swimmer with past medical history of childhood L5 osteochondroma and no tobacco use history. He had no other symptoms or exercise limitation. Initial chest x-ray and lab work were normal. Chest CT revealed mid-tracheal pedunculated mass obstructing >50% of the tracheal diameter. He was admitted to the hospital where bronchoscopy was performed, revealing a multilobulated and vascular-appearing mass. The patient proceeded to thoracic surgery with trans-cervical resection of the mass on 1 tracheal ring. Pathology revealed carcinoma ex pleomorphic adenoma with negative margins. The malignant component of the tumor was negative for MAML2 rearrangement by fluorescent in situ hybridization and was best characterized as high-grade adenocarcinoma, not otherwise specified. PET-CT and brain MRI were negative for metastatic disease. He received 60 Gy of adjuvant radiation therapy 8 weeks following resection. DISCUSSION: Primary salivary gland-type (P-SGT) tumors arise from the seromucinous submucosal glands of the central airways, and unlike their salivary gland counterparts, tend to be malignant.3 P-SGT of the lung are rare and account for 0.1-0.2% of all lung cancer. Mucoepidermoid carcinoma is the most common, followed by adenoid cystic carcinoma and distantly followed by epithelial-myoepithelial carcinoma. Carcinoma ex pleomorphic adenocarcinoma (Ca ex PA) is exceedingly rare, with 11 cases reported in the literature (4 involving the trachea). This tumor has an abrupt transition from a benign pleomorphic adenoma with bland ductal and myoepithelial components to a high grade malignant carcinoma with marked atypia, necrosis and mitotic activity. This is in contrast to the majority of P-SGT tumors, which are typically low grade and carry an overall prognosis of 56.3% survival at 20 years. Average age of onset for P-SGT tumors is the 5th and 6th decades, including pulmonary Ca ex PA (mean age 54y), which makes this discovery in a young patient highly unexpected. For P-SGT tumors, surgical intervention results in significant improvement in overall survival. The optimal treatment for pulmonary Ca ex PA remains unknown with the majority of reported cases receiving complete resection with varying adjuvant use of radiation and/or chemotherapy. CONCLUSIONS: Ca ex PA of the large airways is extremely rare and, in contrast to the majority of other primary salivary gland-type tumors, is high grade. Optimal treatment strategies remain unknown with resection plus radiation and/or chemotherapy being the most common approach to date. Reference #1: Ittrich H, Bockhorn M, Klose H, Simon M. The Diagnosis and Treatment of Hemoptysis. Dtsch Arztebl Int. 2017;114(21):371-381. Reference #2: Molina JR, Aubry MC, Lewis JE, et al. Primary salivary gland-type lung cancer: spectrum of clinical presentation, histopathologic and prognostic factors. Cancer. 2007;110(10):2253-2259. Reference #3: Falk N, Weissferdt A, Kalhor N, Moran CA. Primary Pulmonary Salivary Gland-type Tumors: A Review and Update. Adv Anat Pathol. 2016;23(1):13-23. DISCLOSURES: No relevant relationships by Mark Allen, source=Web Response No relevant relationships by Jennifer Boland, source=Web Response No relevant relationships by Matthew Cecchini, source=Web Response No relevant relationships by Kimberly Johnson, source=Web Response no disclosure on file for Tobias Peikert

A Rare Case of Haemoptysis Revealing Aortic Coarctation in an Adult.

Adult patients with congenital cardiovascular abnormalities such as aortic coarctation may rarely, due to the high pressure and dilation in the bronchial arteries, present with recurrent haemoptysis as the sole clinical sign.A multidetector computed tomography scan contributes significantly to the aetiological diagnosis of haemoptysis in cases of congenital cardiovascular abnormalities.Interventional procedures such as stenting are currently the preferred approach for the treatment of aortic coarctation in adults, with good outcomes.

HYDATID LUNG CYSTS WITH HEMOPTYSIS MIMICKING PULMONARY TUBERCULOSIS

Hydatid cyst of the lung is one of the rare causes of hemoptysis and often diagnosed late. Cystic echinococcosis is the larval cystic stage (echinococcal cysts) of a small taenia-type tapeworm (Echinococcus granulosus) that may cause illness in intermediate hosts, generally herbivorous animals and people who are infected accidentally. We present the case of multiple hydatid cysts in a 10-year-old boy presenting with hemoptysis from an endemic area but with no history of contact. Radiological investigations done were inconclusive, and the patient was started on anti-Koch’s Therapy (AKT) based on a high clinical suspicion. Surgical intervention was planned after 4 months of therapy due to the non-resolution of symptoms and progression of the disease. Histopathology was suggestive of multiple hydatid cysts occupying the right lung lower lobe. The patient was started on Tab Albendazole and the follow-up period was uneventful. A possibility of hydatid cyst in cases of lung infections should be kept in endemic areas irrespective of the history and radiological features. Complete evaluation, along with tissue diagnosis, is important for establishing a confirmative diagnosis of tuberculosis. Empirical treatment with AKT, in cases of suspicion, should be avoided.

Haemoptysis in a toddler: An uncommon presentation of unusual foreign body ingestion

Introduction:Haemoptysis is uncommon in toddler. Lower respiratory tract infections and foreign body are among the common causes.Case Presentation:We are reporting a case of a child presented to emergency department with complaint of mild haemoptysis, whom was later found to have a piece of broken satay skewer at the tonsillar region. The foreign body was removed during the procedure without any complication.Discussion:Foreign body ingestion, particularly a piece of broken satay skewer, is difficult to suspect without a proper history and eyewitness. Therefore, parent’s supervision is important. Emergency residents should have a high index of suspicion of foreign body ingestion in a child with vague symptoms.Conclusion:Foreign body is among the commonest cause of haemoptysis in an afebrile toddler. Acute haemoptysis in otherwise healthy toddler should alert the emergency residents about foreign body ingestion. History of food intake should be more thorough even if trivial.

ASPERGILLUS FUNGUS BALL: HEMOPTYSIS IN PATIENT WITH PRIOR HISTORY OF CURED PULMONARY TUBERCULOSIS

ABSTRACT&#x0D; Lung aspergilloma consists of a fungal mass composed predominantly by Aspergillus fumigatus formed within a prior lung cavity, in greater numbers in healed tuberculosis caverns. Clinically, it is marked by patients in their fourth or fifth decade of life presenting most commonly repeating episodes of small volume of hemoptysis. The present report describes the case of a 66-year-old male patient, admitted with hemoptysis of large amount associated with dyspnea, and past pathological history of hemoptysis episodes more than 24 years after diagnosis and treatment of tuberculosis in 1994. Data were obtained through analysis the patient’s medical records and laboratory and imaging exams performed on the patient during the hospitalization period. This paper highlights a relevant cause of hemoptysis in patients with previous history of tuberculosis and clarifies the clinical and imaging investigation for timely diagnosis and appropriate therapy in such cases.