Episodes Of Hemoptysis Research Articles

Pulmonary Contusion and Traumatic Pneumatoceles in a Platform Diver with Hemoptysis

BackgroundInjuries in divers resulting purely from impact with the water are uncommon in the published literature. We present a case report of pulmonary contusion in a young diver. Case ReportA young, healthy competitive platform diver landed flat on his back in the water from a dive of 10 meters. He complained of upper back pain and had an episode of hemoptysis after the dive. He was initially observed for 15 hours postinjury, and was discharged when three chest radiographs (CXRs) taken at 1, 7, and 11 hours postinjury did not show significant abnormalities. Thirty-six hours postinjury, the patient experienced repeat hemoptysis and returned to the emergency department, where a fourth CXR performed 43 hours postinjury was normal. A computed tomography (CT) scan revealed pulmonary contusion and traumatic subpleural pneumatoceles. The patient was admitted to the cardiothoracic ward for observation. He recovered well with conservative treatment and was discharged on the fifth day after injury with clearance for air travel. In this patient with a high-energy mechanism of rapid deceleration and hemoptysis at the scene, there may be grounds for performing a CT scan of the thorax at the time of the first presentation, although the CT findings did not change conservative management of this patient. Why Should an Emergency Physician Be Aware of This?Emergency physicians should recognize that a dive into water may generate sufficient impact to produce a pulmonary contusion. If the patient is clinically well and the CXR results are normal, the decision to initiate a CT scan and subsequent disposition may be based on clinical judgement and institutional practice.

CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature.

Video-assisted thoracoscopic surgery (VATS) is standard of care for small lung resections at many centres. Computed tomography (CT)-guided insertion of microcoils can aid surgeons in performing VATS resections for non-palpable lung nodules deep to the lung surface. Retrospective analysis of CT-guided microcoil insertions prior to VATS lung resection at a single institution from October 2008 to January 2014. A total of 63 patients were included (37% male, mean age 61.6±11.4 years). Forty-two patients (67%) had a history of smoking, with 10 current smokers. Sixty one (97%) patients underwent wedge resection and 3 (5%) patients had segmentectomy. Three (5%) patients required intra-operative staple line re-resection for positive or close margins. Eleven (17%) patients had a completion lobectomy, 5 of which were during the same anaesthetic. The average time between the CT-guided insertion and start of operation was 136.6±89.0 min, and average operative time was 84.0±53.3 min. The intra-operative complication rate was 5% (n=3), including 1 episode of hemoptysis, and 2 conversions to thoracotomy. The post-operative complication rate was 8% (5 patients), and included 2 air leaks, 1 hemothorax (drop in hemoglobin), 1 post chest tube removal pneumothorax, and one venous infarction of the lingula after lingula-sparing lobectomy requiring completion lobectomy. . Average post-operative length of stay was 2.2 days. A diagnosis was made for all patients. CT-guided microcoil insertion followed by VATS lobectomy is safe, with short operative times, short length of stay and 100% diagnosis of small pulmonary nodules. This technique will become more important in the future with increasing numbers of small nodules detected on CT as part of lung cancer screening programs.

Coinfección de tuberculosis y candidiasis pulmonar en paciente previamente sana

Antecedentes:La coexistencia entre los hongos patógenos y la tuberculosis pulmonar es una condición clínica que se produce generalmente en pacientes inmunosuprimidos, sin embargo, los pacientes inmunocompetentes puede tener esta condición con menor frecuencia.Objetivo:Presentamos el caso de un paciente inmunocompetente con diagnóstico de una coinfección de tuberculosis Mycobacterium tuberculosis y Candida albicans.Caso clínico:Paciente femenina de 22 años con cuadro abrupto de tos, fiebre y hemoptisis sin antecedentes de enfermedad.Hallazgos clínicos y métodos diagnósticos:Al examen respiratorio se halló disminución del murmullo vesicular en la región apical y estertores crepitantes basales en el pulmón izquierdo. Se realizó estudios microbiológicos de muestras tomadas por expectoración y por fibrobroncoscopia en el que se incluyó la tinción de Ziehl-Neelsen, cultivo para micobacteria y hongos en medio Agar Dextrosa Sabouraud y filamentización en suero obteniéndose positividad para Mycobacterium tuberculosis y Candida albicans.Tratamiento y resultado:Se le realizó manejo con antifímicos de primera categoría y antimicóticos con buena respuesta clínica.Relevancia clínica:La coinfección fúngica y tuberculosis pulmonar no es frecuente en pacientes inmunocompetentes, debe sospecharse en episodios abruptos de hemoptisis.

148 A service evaluation of a structured walking programme for cystic fibrosis patients

Objectives: The importance of physical activity in CF is well recognised and has positive benefits to health and quality of life. However the uptake of exercise is often disappointing with many barriers identified. Many issues can be addressed by offering out-patient exercise programmes to patients, but distance or fatigue from travelling to the CF centre may prohibit some patients from attending such sessions. This case study evaluated the use of video-conferencing to deliver a weekly exercise programme to a patient unable to regularly attend. Methods: A 41 year old female patient with an FEV1 of 40% and a six minute walk test result of 620 metres previously participated in regular exercise. However, due to recurrent episodes of haemoptysis over a six month period, she lost confidence and no longer exercised with a resulting fall in exercise tolerance. As distance precluded her from attending the CF centre for regular supervised exercise sessions, a secure video-conferencing system was used to deliver weekly exercise sessions. 12 weekly sessions were delivered over a 3 month period. Each session commenced with an assessment of the patient’s signs and symptoms and the session adjusted accordingly. Results: The patient felt the level of supervision offered by the videoconferencing was essential to enable her to exercise effectively and saw significant improvements to her reported exercise tolerance. She reported improved confidence and motivation to continue with exercise. Conclusion: Video-conferencing can successfully be used to deliver supervised exercise to patients who live in remote locations or who are fatigued by travelling to the CF centre.

Focal Alveolar Hemorrhage: A Unique Presentation of ANCA-Associated Vasculitis

SESSION TITLE: Pulmonary Manifestations of Systemic Disease SESSION TYPE: Case Report Slide PRESENTED ON: Saturday, April 16, 2016 at 09:45 AM - 11:15 AM INTRODUCTION: Pulmonary renal syndromes are rare clinical entities that can present with diffuse alveolar hemorrhage (DAH) and glomerulonephritis. They are often a result of anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitides (AAV). Typically, alveolar involvement in pulmonary renal syndromes is multi-lobar and bilateral. We describe a case of crescentic glomerulonephritis presenting with hemoptysis and focal alveolar involvement limited to the left lung. CASE PRESENTATION: A 58-year-old woman presented to the hospital reporting a one week history of 2-4 teaspoons of hemoptysis daily with left-sided pleuritic pain. On further assessment, she was found to have acute kidney injury with microhematuria and proteinuria. P-ANCA and myeloperoxidase (MPO) antibody were positive. Acid-fast studies and cultures of blood, urine, and sputum were negative. Bronchoscopy was done showing hemorrhage localized to the left upper lobe. Renal biopsy showed crescentic glomerulonephritis without evidence of granulomas consistent with microscopic polyangiitis. DISCUSSION: AAVs are a small group of vasculitides which include granulomatosis with polyangiitis, microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis, and pauci-immune vasculitis. ANCAs trigger a self-perpetuating inflammatory state when they bind to antigens in the cytoplasmic granules of neutrophils. In the lungs, this inflammation results in diffuse alveolar hemorrhage. In our patient, the constellation of p-ANCA and MPO antibodies, hemoptysis, and crescentic glomerulonephritis without granulomas is highly indicative of MPA. This unique presentation of focal hemorrhage demonstrates that although bilateral disease is classic, AAV should not be excluded in cases of unilateral involvement. Furthermore, repeat imaging over the next 48 hours demonstrated progression to bilateral disease, suggesting DAH may begin as focal disease that generalizes in time. Our patient received high dose steroids, plasma exchange, and rituximab. She was discharged home with improving renal function and without further episodes of hemoptysis. CONCLUSIONS: Although AAV with pulmonary hemorrhage usually presents as a diffuse process, this case demonstrates that it may initially present as a focal area of hemorrhage. These findings underscore the importance of maintaining a high degree of clinical suspicion in patients who do not present classically so that aggressive treatment can be initiated. Reference #1: Gómez-Puerta, J. A., Hernández-Rodríguez, J., López-Soto, A., & Bosch, X. (2009). Antineutrophil cytoplasmic antibody-associated vasculitides and respiratory disease. CHEST Journal, 136(4), 1101-1111. Reference #2: Lally, L., & Spiera, R. F. (2015). Pulmonary Vasculitis. Rheumatic Disease Clinics of North America, 41(2), 315-331. Reference #3: Lichtenberger, J. P., Digumarthy, S. R., Abbott, G. F., Shepard, J. A. O., & Sharma, A. (2014). Diffuse pulmonary hemorrhage: clues to the diagnosis. Current problems in diagnostic radiology, 43(3), 128-139. DISCLOSURE: The following authors have nothing to disclose: Kosal Seng, Timothy Vossler, Michael Kendall, Santhi Iyer Kumar No Product/Research Disclosure Information

Hemoptysis Due to Anterior Scoliosis Implants: A Case Report.

A twenty-five-year-old man presented with recurrent episodes of hemoptysis requiring hospitalization and interventional embolization. Instrumentation that had been implanted ten years previously for anterior spinal correction and fusion to treat adolescent idiopathic scoliosis adjoined the medial border of the right lung. The instrumentation eroded the lung during respiration, which prompted the formation of adhesions and fibrosis. Because of the risk of additional hemoptysis events, we performed revision thoracotomy, removal of the spinal instrumentation, and partial lobectomy. This rare and serious complication underscores the importance of meticulous surgical technique to ensure proper implant placement and of vigilant monitoring for late iatrogenic injury.

Infected aortic aneurysmal rupture masquerading as pneumonia.

Learning point for clinicians This case report highlights (i) The importance of ruling out infectious aortic aneurysm in a patient with rapidly expanding lung infiltrates with signs of sepsis and respiratory symptoms. (ii) The rare occurrence of fusobacterium bacteremia secondary to infected aneurysm. A 59-year-old male with history of hypertension, presented with substernal chest pain, vomiting, fever and one episode of hemoptysis. Patient was admitted a week ago with similar pain and stress ECHO was negative for ischemia. He had presented to the ED (emergency department) 4 days ago, was diagnosed with pneumonia and was discharged on levofloxacin. The new onset of hemoptysis and the persistent symptoms prompted him to come to the ED again. He had a 10 pack year smoking history, consumed alcohol every day and used marijuana. He was tachycardic, but otherwise hemodynamically stable and was saturating …

ECG In Evaluation for Pulmonary Thromboembolism- Occam's Razor or Hickam's Dictum?

The electrocardiogram (ECG) is a simple, universally available tool in emergency departments used in evaluation of acute chest pain. Among the differential diagnosis, Acute Pulmonary Thromboembolism (PTE) is important to recognize as the diagnosis, carries serious therapeutic and prognostic implications. A 28-year-old male presented to the emergency department with acute onset shortness of breath and chest pain for two days and two episodes of haemoptysis. He had sustained a road traffic accident with fracture of both bones of right leg one month back for which he had undergone open reduction and internal fixation. On examination, he was tachycardic (pulse rate-152/min) and tachypnoeic (respiratory rate-26/min) with normal blood pressure (116/78 mm of Hg) and oxygen saturation (96%) on breathing ambient air. His right lower limb was warm and swollen with tenderness along the femoral vein. The electrocardiogram (ECG) showed sinus tachycardia, right ventricular strain, right bundle branch block pattern and S1Q3T3 pattern [Table/Fig-1] suggestive of PTE. Compression ultrasound scan of right lower limb revealed echogenic contents in right femoro-popliteal veins indicative of Deep Vein Thrombosis (DVT). Computed tomographic angiogram of pulmonary arteries showed hypodense filling defect suggestive of thrombus involving the right main pulmonary artery [Table/Fig-2], extending into its descending branch. A 2-dimensional echocardiogram showed mild tricuspid regurgitation and mild right ventricular dilatation. Since the patient was haemodynamically stable, thrombolysis was not attempted. He was started on subcutaneous enoxaparin at 1 mg/kg/dose twice daily along with oral anticoagulation with warfarin. Patient improved and was discharged. On follow-up at one month, patient is asymptomatic for DVT or PTE and INR is in therapeutic range. [Table/Fig-1]: A 12-lead electrocardiogram (ECG) showing sinus tachycardia (heart rate- 150/min), right bundle branch block pattern (black arrows), T-inversion in aVF and typical S1Q3T3 pattern (red arrows) suggestive of pulmonary thromboembolism. [Table/Fig-2]: Axial computed tomographic angiogram section of pulmonary arteries showing hypodense filling defect (arrowhead) suggestive of thrombus involving the right main pulmonary artery. Common ECG abnormalities in PTE include sinus tachycardia and T wave inversions in precordial leads and a ventricular fibrillation (VF), right bundle branch block pattern, S1Q3T3 pattern, QR pattern in V1, QS pattern in precordial leads, ST-elevation in precordial leads and low voltage in limb leads. Classic changes like S1Q3T3 pattern tend to occur with more severe forms of PTE and correlate well with mortality [1]. S1Q3T3 pattern is a marker of acute cor-pulmonale and can occur with conditions like severe bronchospasm and pneumothorax [2]. Composite scores based on ECG in PTE can help in patient management. Using a 21-point scale, a score ≤3 in predicted normal right ventricular function [3]. QR in V1, ST-depression in V4-V6 and ST-elevation in lead III and V1 are associated with in-hospital mortality [1]. This case illustrates the classical ECG findings of PTE and the importance of an easily available, simple diagnostic test in diagnosing a life threatening condition. The classical signs in ECG can be used as a decision tool for further imaging and can also be used as an indicator for early referral of a patient especially in resource poor settings. To conclude, ECG in PTE can show a spectrum of changes from being normal to having multiple suggestive abnormalities. The ECG changes in PTE are not specific and similar changes may result from wide array of causes conferring to the principle of Hickam’s dictum. In general, the number of abnormalities on ECG correlates well with pulmonary artery pressures and the severity of PTE. Even though ECG can give a clue to the diagnosis of PTE, its actual role lies in prognostic assessment and hence can be used as a decision tool for further imaging and investigations especially in resource poor settings.

The administration of aerosolised medications in bronchiectasis: the rediscovery of an old method

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Aspiration of Grass Head with Subsequent Migration to the Lung Periphery

A 9-year-old boy was referred to pediatric pulmonology with hemoptysis. There was history of a possible foreign body aspiration event that had occurred 4 months previously. Computed tomography scan of the chest demonstrated right lower lobe atelectasis. However, flexible fiber-optic bronchoscopy did not reveal any foreign body in the airway. Over the following month, there were two additional episodes of hemoptysis. In consultation with pediatric surgery, the child went to the operating room for video-assisted thoracoscopy. This revealed that there was an aspirated grass head that had migrated to the lung periphery.

Prognosis and Predictors of Rebleeding After Bronchial Artery Embolization in Patients with Active or Inactive Pulmonary Tuberculosis.

The aim of this study was to characterize the prognosis and identify factors that contribute to rebleeding after bronchial artery embolization (BAE) in patients with active or inactive pulmonary tuberculosis (PTB). Following a retrospective review, 190 patients had hemoptysis requiring BAE due to PTB in one hospital between 2006 and 2013. The median age at the time of diagnosis of PTB was 37 years and 54 years at the time of first episode of hemoptysis. Among 47 patients (24.7 %) who experienced rebleeding after BAE during the median follow-up period of 13.9 months [interquartile range (IQR) 2.3-36.0 months], bleeding recurred in 12 patients (6.3 %) within 1 month and in 15 patients (7.9 %) after 1 year. The median non-recurrence time was 8.6 months (IQR 1.2-27.6 months). Independent predictors of rebleeding after BAE were tuberculous-destroyed lung [hazard ratio (HR) 3.0; 95 % confidence interval (CI) 1.5-6.2; p = 0.003], the use of anticoagulant agents and/or antiplatelet agents (HR 2.6; 95 % CI 1.1-5.8; p = 0.022), underlying chronic liver disease (HR 2.7; 95 % CI 1.1-4-6.9; p = 0.033), elevated pre-BAE C-reactive protein (CRP) (mg/dL) (HR 2.4; 95 % CI 1.0-5.5; p = 0.048), and the existence of fungal ball (HR 2.1; 95 % CI 1.0-4.3; p = 0.050). The risk of rebleeding after BAE in active or inactive PTB was high, particularly in patients with tuberculous-destroyed lung, chronic liver disease, the use of anticoagulant agents and/or antiplatelet agents, elevated pre-BAE CRP, and the existence of fungal ball.

Right intralobar sequestration with arterial supply from left gastric artery

A 61-year-old man with recurrent episodes of haemoptysis and pneumonia underwent chest CT scan showing an intralobar sequestration in the right lower lobe (figure 1); at the multiplane CT reconstruction,...

Diffuse Alveolar Hemorrhage Confirmed by Bronchoalveolar Lavage in a Patient with Hemoptysis after Sildenafil Use for Erectile Dysfunction

A 81-year-old man was referred for respiratory failure by emergency medical technicians. He admitted at intensive care unit for ventilator treatment. Several hours before admission, he took sildenafil 100 mg for erectile dysfunction without prescription. The episodes of hemoptysis occurred several hours later. Computed tomography revealed multifocal diffuse ground-glass attenuation in both lungs. And the more we performed bronchoalveolar lavage, the more the color of it was turned into red. We treated him with empirical antibiotics and tranexamic acid, and hemoptysis was stopped in one day after admission. But in the 5th admission day, he died from sepsis combined with pneumonia caused by Acinetobacter baumannii abruptly.

Respiratory symptoms as an initial presentation of choriocarcinoma

Chronic dyspnea, chest pain, cough, and hemoptysis for more than 2 weeks often indicate a diagnosis of infective etiology of the respiratory tract in a tropical country. However, in a young reproductive female, these complaints with an episode of hemoptysis may rarely be the presenting symptomatology of pulmonary metastasis of choriocarcinoma. A young female of reproductive age group presented with hemoptysis, cough, and breathlessness. Chest X-ray revealed bilateral lower lobe opacities. Fine-needle aspiration cytology of the lung lesions depicted choriocarcinoma metastasis. Ultrasonography and magnetic resonance imaging revealed endomyometrial mass lesion suggestive of invasive gestational trophoblastic disease. β hCG levels were high. Dilatation and curettage and histopathological analysis of the mass confirmed the diagnosis of choriocarcinoma. This young female who presented with respiratory complaints was finally diagnosed to be a case of choriocarcinoma with lung metastasis. Therefore, choriocarcinoma metastasis must be considered as a differential diagnosis in a female of childbearing age presenting with respiratory complaints and hemoptysis.

Difficult airway after late postoperative bleeding in a case of total thyroidectomy, tracheal resection and reconstruction.

Difficult airway after late postoperative bleeding in a case of total thyroidectomy, tracheal resection and reconstruction.

Radiologic management of haemoptysis: diagnostic and interventional bronchial arterial embolisation.

Hemoptysis can be a life-threatening pulmonary emergency with high mortality, is symptomatic of an underlying severe pulmonary disease and requires immediate diagnosis and treatment. Diagnostically, bronchoscopy, conventional chest x-ray and contrast-enhanced multislice computed tomography (MSCT) with CT angiography (CTA) provide information regarding the underlying pulmonary disease, bleeding site, the vascular anatomy of the bronchial arteries (BA) and extrabronchial branches, as well a basis for planning of endovascular intervention. Therapeutically, bronchial artery embolization (BAE) is a safe and effective technique in the hands of an experienced interventionist with profound knowledge of the BA anatomy and possible pitfalls as well as experience with first-line therapy of recurrent and massive hemoptysis or as an intervention prior to elective surgery. Recurrent episodes of hemoptysis are not uncommon and require a prompt repeat BAE after exclusion of extrabronchial systemic and pulmonary artery bleeding sources. This review article should give an overview of the history, anatomical and pathophysiological basics and the clinical context of hemoptysis and diagnosis, as well as a survey of management, treatment and results of BAE. Hemoptyses are life threatening and require urgent diagnostic and therapy. Chest x-ray, bronchoscopy, and contrast-enhanced MSCT with CTA should be carried out before therapeutic bronchial artery embolization (BAE). BAE for the treatment of massive and recurrent hemoptysis is safe and effective. False embolization in spinal branches of BA are the most serious complication of a BAE. Repeatedly BAE refractory cases should undergo elective surgery.

A rapid change in a patient's chest radiograph appearances

A 72-year-old man with a history of rheumatoid arthritis (on multiple immunosuppressants: leflunomide, etanercept and hydroxychloroquine) was admitted with headache and fever. He had no other symptoms or relevant medical...

Hemoptysis in Children : Single Center Experience

celiac disease and another had Wagener disease. Of the 55 patients with localized pulmonary hemorrhage the most common cause was cystic fibrosis (30%) and congenital heart disease (27%), followed by pulmonary arteriovenous malformation (8%), ruptured hydatid cysts (7.3%) and retained foreign body (5.4%). Fifty one out of the 55 (92.7%) with localized hemorrhage had localized patch on the chest x-ray; 40% had previous x-ray within the previous two years showing the same radiological patch at the time of hemoptysis episodes. Massive hemoptysis was found in three patients. Diagnostic flexible bronchoscopy was done in all patients within one week of the episode of hemoptysis. High resolution chest CT-scan was done for all patients with the diffuse type. Dynamic chest CT-scan was done in 50% of patients with localized hemorrhage. Embolization was done in five patients with AV malformation and two patients with cystic fibrosis. Surgical lobectomy was done in those with sequestration, hydatic cyst and one patient with foreign body and another one with localised bronchiectasis.

Association of influenza-like illness and climatic parameters with hemoptysis.

Although some authors have suggested that there is some seasonal periodicity of hemoptysis, or relation to respiratory tract infections, the association of influenza or climatic parameters with hemoptysis has been poorly investigated. Our aim was to describe the relationship between influenza and climatic parameters with severe hemoptysis that required bronchial artery embolization (BAE). All consecutive subjects with at least one episode of hemoptysis that required BAE during a 5-y period were included. We applied a general multivariable additive seemingly causal model corresponding to a lagged variable autoregressive model with the exogenous variables as monthly mean temperature, lagged monthly mean temperature (-1), and monthly mean influenza activity, and the number of embolizations as the endogenous variable. We found a significant association between severe hemoptysis requiring BAE and low monthly mean temperature and influenza activity. Other climatic factors, such as atmospheric pressure, rainfall, relative humidity, or wind speed, failed to show significant association with the occurrence of life-threatening hemoptysis. There is a strong long running relationship between severe hemoptysis and low monthly mean temperature. A weaker association of hemoptysis with influenza activity was also found.

English

AIMS: This paper describes assessment of patients with air fluid levels on chest radiography of uncommon etiology. STUDY DESIGN: A review of literature on air fluid levels on chest radiography is described and differential diagnosis is summarized. The case of a young girl with recurrent episodes of hemoptysis and the case of another woman with breathlessness are presented. PRESENTATION OF CASES: The patients were admitted through emergency department where they were assessed and treated in a medical intensive care unit with the involvement of internal medicine team. Laboratory work up confirmed the diagnosis of bronchogenic cyst and hydatid cyst. Medical treatment was administered and supportive care was undertaken. Patients were referred to the cardiothoracic surgeon for lobectomy/cystectomy. DISCUSSION: Air fluid levels seen on chest roentgenogram due to many pulmonary like hydropneumothorax, lung abscess, fluid filled cavity, bullae, cyst and some non-pulmonary causes like diaphragmatic hernia. It is important to identify the exact cause as the further management would be dependent on that. CONCLUSIONS: These cases emphasize that practitioners should consider uncommon etiologies in patients with air fluid levels chest radiography.