Episodes Of Hemoptysis Research Articles

Efficacy of adalimumab therapy for life-threatening pulmonary vasculitis in Behçet’s disease

Inflammatory large-vessel vasculitis in Behçet's disease may cause life-threatening arterial aneurysms that are prone to rupture. We report a patient with Behçet's disease with right ventricular thrombus and large aneurysms of the pulmonary arteries that led to recurrent episodes of hemoptysis. Following relapses and only partial response to repeated courses of cyclophosphamide and steroids, the patient was treated with adalimumab (Humira) and is now in clinical remission for over 30 months, with regression of her pulmonary lesions. Anti-TNFα treatment is a potential therapeutic option in patients with life-threatening complications due to large-vessel vasculitis.

Hemoptysis with diagnostic dilemma

Hemoptysis is a common symptom. Although initial diagnostic workup, including a chest radiograph, often gives a clue to the cause, it provides no diagnostic hints in 3.0–42.2% of episodes of hemoptysis. To describe those cases with no diagnostic hints at initial investigations, experts have used different terms, including unexplained hemoptysis, idiopathic hemoptysis, cryptogenic hemoptysis and hemoptysis with normal chest radiographs. As hemoptysis is a common symptom of bronchogenic carcinoma, there is a concern of having underlying malignancy. Physicians value high-resolution computed tomography and fiberoptic bronchoscopy as the next investigations to establish diagnosis. These investigations however are expensive and nonspecific results are common in those cases of hemoptysis where initial diagnostic workup gives no clues to the cause. As a result, controversies exist with regard to their use. In this article, the author has proposed diagnostic approaches to evaluate those cases of hemoptysis with no diagnostic hints at initial investigation, after extensive review of published articles related to the case scenario.

An Occult Congenital Fistula Between the Descending Aorta and the Left Pulmonary Vein in an Adult Presenting With Recurrent Episodes of Hemoptysis

We report a case of recurrent hemoptysis due to an occult congenital fistula between the descending aorta and the left pulmonary vein in a 25-year-old female patient. The anomaly was confirmed by contrast-enhanced CT scan and angiography. No abnormality was noted in the bronchia and pulmonary arteries. The patient was successfully managed by simple ligation of the fistula. To our knowledge, this is the first reported case of adult-onset hemoptysis caused by an occult congenital fistula between the descending aorta and a pulmonary vein.

Mucoepidermoid Carcinoma of the Tongue Base Mimicking an Ectopic Thyroid

A 69-year-old woman with mucoepidermoid carcinoma (MEC) of the tongue base came under our observation complaining of repeated episodes of haemoptysis. Mucoepidermoid carcinoma of the tongue base gives rise to a rather vague and aspecific symptomatology. Early symptoms include foreign body sensation in the oral cavity, undefined paraesthesia, and sialorrhoea. With the progression of disease, dysphagia, otalgia, and painful swallowing are usually referred. We report a case of mucoepidermoid carcinoma of the tongue base mimicking an ectopic thyroid.

Temporal patterns in severe hemoptysis requiring bronchial artery embolization

Background: Although some authors have suggested that there is some seasonal periodicity in hemoptysis, temporal patterns of hemoptysis have been poorly investigated. The aim of this study is to describe the temporal pattern of severe hemoptysis which required bronchial artery embolization (BAE). Methods: All consecutive patients with at least one episode of hemoptysis which required BAE during a 13-year period were included. Recurring hemoptysis requiring BAE in a patient with previous embolization was included as a new hemoptysis event, unless it occurred within one month from the prior event. Lineal regression was applied to compute the tendency of occurrence of cases along 13 years of record data. The daily and monthly distributions of embolizations were used to study the weekly and monthly seasonal indexes. Results: Hemoptysis requiring BAE occurred with some monthly variation demonstrated with two monthly peaks, with the first one occurring during April and the second one during November. Conclusion: Hemoptysis occurred with two monthly peaks. This seasonal trend might be due to different prevalence of respiratory tract infections or to some weather variables. Identification of significant environmental factors could be useful to improve preventive measures.

Temporal patterns in severe hemoptysis requiring bronchial artery embolization

BackgroundAlthough some authors have suggested that there is some seasonal periodicity in hemoptysis, temporal patterns of hemoptysis have been poorly investigated. The aim of this study is to describe the temporal pattern of severe hemoptysis which required bronchial artery embolization (BAE).MethodsAll consecutive patients with at least one episode of hemoptysis which required BAE during a 13-year period were included. Recurring hemoptysis requiring BAE in a patient with previous embolization was included as a new hemoptysis event, unless it occurred within one month from the prior event. Lineal regression was applied to compute the tendency of occurrence of cases along 13 years of record data. The daily and monthly distributions of embolizations were used to study the weekly and monthly seasonal indexes.ResultsHemoptysis requiring BAE occurred with some monthly variation demonstrated with two monthly peaks, with the first one occurring during April and the second one during November.ConclusionHemoptysis occurred with two monthly peaks. This seasonal trend might be due to different prevalence of respiratory tract infections or to some weather variables. Identification of significant environmental factors could be useful to improve preventive measures.

Wegener’s granulomatosis in a middle-aged woman presenting with dyspnea, rash, hemoptysis and recurrent eye complaints: a case report

IntroductionWegener’s granulomatosis presenting as diffuse alveolar hemorrhage is uncommon. However, the recognition of multisystem disease involving joints, kidney, eye and lung is critical for diagnosing Wegener's vasculitis. This is not the first report of this kind in the literature.Case presentationA 51-year-old Croatian woman presented to our Emergency Department with a history of progressively worsening productive cough and shortness of breath, epistaxis and two episodes of hemoptysis. She developed respiratory failure due to diffuse alveolar hemorrhage, which was successfully treated with high-dose steroids, cyclophosphamide and plasmapheresis. Her clinical course was complicated with methicillin-resistant Staphyloccocus aureus pneumonia, which has been associated with Wegener’s granulomatosis flares.ConclusionThe recognition of multisystem disease is critical for diagnosing Wegener's vasculitis. Diffuse alveolar hemorrhage can be a fulminant manifestation of Wegener’s granulomatosis, in which case immediate and aggressive treatment with pulse steroids, high-dose cyclophosphamide and plasma exchange can be life-saving.

Unexplained Recurrent Upper and Lower Respiratory Tract Infections in Otherwise Young Healthy Male

SESSION TYPE: Airway Global Case Report Posters

Rare Primary Tracheal Tumor in a Middle-Aged Asian Male

Abstract SESSION TYPE: Cancer Cases IPRESENTED ON: Monday, October 22, 2012 at 01:45 PM - 03:00 PMINTRODUCTION: Ewing Sarcoma (ES)/Primitive neuro-ectodermal tumor (PNET) is a rare malignant tumor with a predilection for males with the ratio of 1.4 to 1[1]. This tumor usually occurs in bones and extraskeletal occurrences (particularly airways) is exceedingly rare[2].CASE PRESENTATION: A 45 year-old Asian non-smoking male with past medical history significant for coronary artery bypass on aspirin, plavix, and coumadin presented to the ER complaining of multiple episodes of hemoptysis over 24 hours. The patient was found to have coumadin-induced coagulopathy which was reversed with fresh frozen plasma. CT scan of the neck and thorax revealed only a mass in the proximal trachea. Bronchoscopy confirmed a tracheal mass on the posterior wall 3 cm from the carina. A 10mm x 9mm multi-lobulated mass was excised with electrocautery hot loop. H aE stained sections revealed hyperchromatic population of cells underlying the normal respiratory epithelium with moderate pleomorphism and mitotic activity. Immunoperoxidase stains were positive for vimentin and synaptophysin. They were negative for S100. Tumor was found strongly positive for CD99. Fluorescescence in-situ hybridization (FISH) demonstrated 99% of cells positive for EVSR1 gene at chromosome 22q12. Patient was given a final diagnosis of Ewing Sarcoma.DISCUSSION: ES /PNET is a malignant tumor that usually occurs in flat and long bones primarily in caucasian children and young adults rarely affects other ethnic groups [3]. Immuno-histochemical staining with CD99 is supportive of ES/PNET tumors is required to make a definitive diagnosis [2]. FISH procedure confirms the diagnosis through detection of the highly specific translocation of EWSR1 gene on 22q12 [3]. There have been reports of primary extraskeletal ES/PNET tumors in the lung, but only one has been reported in the tracheobronchial tree [1].CONCLUSIONS: The first case of primary ES/PNET of the trachea was described in 2010 by Elmi et al [1], which presented with acute airway obstruction and hemoptysis. We present the second case of ES/PNET in the trachea. However this is the first documented case on a middle age asian-male.1) Elmi, Maryam et al. Primary tracheal Ewing's sarcoma. Annals of Thoracic Surgery. 2010 oct;90(4):1349-52.2) Ushigome S, Machinami R, Sorensen PH. Ewing sarcoma/primitive neuroectodermal tumour (PNET). In: FletcherCDM, UnniKK, MertensF, editors. Pathology and genetics of tumours of soft tissue and bone. World Health Organization classification of tumours. Lyon: IARC Press, 2002: 297-3003) Jennifer Worch, et al.Racial differences in the incidence of mesenchymal tumors associated with EWSR1 translocation. Cancer Epidemiology, Biomarkers and Prevention. 2011 Mar;20(3):449-53DISCLOSURE: The following authors have nothing to disclose: Nelson Medina, Navneet Arora, Pratick Patel, Nazly ShariatiNo Product/Research Disclosure InformationNewark Beth Israel Medical Center, New Jersey, Iselin, NJ.

Hemoptisis amenazante: estudio de 154 pacientes

Background and objectivesThe natural history of life-threatening hemoptysis (LTH), a medical emergency, is ill defined. The objective of the study was to evaluate, in a university teaching hospital setting, the etiology, methods used, and evolution of LTH. Patients and methodsProspective study in which we enrolled 154 patients admitted for LTH over 3 consecutive years. Bronchoscopy and arteriography procedures were performed, as prescribed by the attending physician. Patient evolution was followed 5 years post-event. Result79.2% were male. Average age was 57 (SD 15) years. Bronchiectasis and active tuberculosis and its consequences were the predominant etiologies. A total of 4.5% patients died as a result of LTH. Bronchoscopy was more effective in identifying the bleeding than arteriography when the examination was performed during an episode of hemoptysis (84.2 versus 20.4%) (P<.001). When embolization or bronchoscopy were used as first measure, embolization was more effective in stabilizing bleeding than bronchoscopy (87 versus 53.5%) (P<.001) in admitted patients. LTH relapse was 10.7%, while it was lower with embolization. ConclusionsLeading causes were bronchiectasis and tuberculosis. While bronchoscopy during a hemoptysis episode was effective in identifying the source of the bleeding, artery embolization was more effective in stabilizing the patient both at the short and long term.

Isolated unilateral absence of pulmonary artery mimicking chronic pulmonary embolism at chest X-ray: multidetector-row CT angiographic findings

Unilateral absence of pulmonary artery (UAPA) is a rare congenital anomaly which can seldom be isolated (1:200,000) and incidentally discovered in adulthood. We describe the case of a 54-year-old male patient who was found to have isolated UAPA (IUAPA) during the clinical and radiological investigation of a single episode of hemoptysis. Although abnormal, chest X-ray findings differed considerably from those previously reported and the diagnosis was only achieved by multidetector-row computed tomography angiography and later confirmed by bed-side echocardiography. Further clinical and instrumental investigation revealed systemic hypertension (158/95 mmHg) and bilateral mild hydronephrosis which both remitted after transurethral prostatic adenomyomectomy.

Tuberculosis Screening before Anti–Hepatitis C Virus Therapy in Prisons

Tuberculosis Screening before Anti–Hepatitis C Virus Therapy in Prisons

Clinical Manifestations and Long-Term Follow-Up in Pediatric Patients Living at Altitude With Isolated Pulmonary Artery of Ductal Origin

This study's aim was to define the clinical manifestations and long-term outcome of pediatric patients living at altitude with isolated pulmonary artery (PA) of ductal origin (IPADO). This was a retrospective cohort study of 17 consecutive cases of IPADO at a single center. All patients lived at modest altitude (median 2050 m [range 1700 m to 3050 m]). Fifteen children (88%) were symptomatic at presentation. High-altitude pulmonary edema was present in 2 patients (12%) at diagnosis, and only 1 patient had episodes of hemoptysis during follow-up. Fourteen patients (82%) demonstrated evidence of pulmonary arterial hypertension (PAH). Among 14 patients with PAH, 11 patients had surgical interventions. PAH resolved in 5 of 11 patients (45%) undergoing surgical rehabilitation. One patient died during follow-up, and 7 patients are receiving oral vasodilator therapies due to residual PAH; 14 patients remained asymptomatic. Our study showed that early intervention in patients with IPADO at modest altitude can potentially rehabilitate the isolated PA and reverse PAH. Whether surgery is indicated for patients with this disorder in the absence of PAH is unknown.

Prise en charge des hémoptysies massives

Massive hemoptyses are serious clinical conditions that can quickly jeopardize the vital prognosis. The major risk is asphyxiation, due to the bleeding into the tracheobronchial tree. The clinician should provide in parallel support for diagnosis and treatment, locating the bleeding but also finding its cause. Such patients should be cared for by a multidisciplinary team, having quick access to an important technical support. The association fiberoptic bronchoscopy-chest CT scan seems to be the most effective to locate and identify the cause of the bleeding. The development of bronchial artery embolization has revolutionized the management of these patients, replacing surgery in many of its indications. The latter still keeps a place in the management of these patients. Indeed, it is the main etiological treatment, preventing the vast majority of recidivism. It is absolutely indicated in the treatment of bleeding from the pulmonary vessels, and in case of failure of other techniques. It should be performed whenever possible away from the episode of hemoptysis, in order to minimize the operative risk.

Chronic necrotizing pulmonary aspergillosis presenting as bilateral pleural effusion: a case report

IntroductionChronic necrotizing pulmonary aspergillosis is an uncommon subacute form of Aspergillus infection. It typically occurs in immunocompromised individuals and in those with underlying lung disease. This interesting case highlights the occurrence of this entity of aspergillosis in an immunocompetent middle-aged woman with atypical radiological findings. To the best of our knowledge this is the first case report of chronic necrotizing pulmonary aspergillosis presenting with pleural effusion.Case presentationOur patient was a 64-year-old Malay woman with a background history of epilepsy but no other comorbidities. She was a lifelong non-smoker. She presented to our facility with a six-month history of productive cough and three episodes of hemoptysis. An initial chest radiograph showed bilateral pleural effusion with bibasal consolidation. Bronchoscopy revealed a white-coated endobronchial tree and bronchoalveolar lavage culture grew Aspergillus niger. A diagnosis of chronic necrotizing pulmonary aspergillosis was made based on the clinical presentation and microbiological results. She responded well to treatment with oral itraconazole.ConclusionsThe radiological findings in chronic necrotizing pulmonary aspergillosis can be very diverse. This case illustrates that this condition can be a rare cause of bilateral pleural effusion.

Allergic bronchopulmonary aspergillosis in a patient with chronic obstructive pulmonary disease

Allergic bronchopulmonary aspergillosis (ABPA) is a debilitating lung disease which occurs as a result of interplay between a variety of host and environmental factors. It occurs in certain susceptible individuals who develop hypersensensitivity to the colonised Aspergillus species. ABPA is a complicating factor in 2% of patients with asthma and is also seen in patients with cystic fibrosis. Asthma and chronic obstructive pulmonary disease (COPD) are known to share key elements of pathogenesis. It is well known that ABPA can occur in patients with asthma, but it has recently been reported in patients with COPD as well. We report a 55-year-old male ex-smoker who presented with complaints of exertional breathlessness and productive cough for five years and an episode of haemoptysis four days prior to presentation. Spirometery showed airflow obstruction which was not reversible with bronchodilators. Chest CT scan revealed paraseptal emphysema along with central bronchiectasis (CB) in the right upper lobe and bilateral lower lobes. A type I skin hypersensitivity reaction to Aspergillus species was elicited. He fulfilled the serological criteria for ABPA and was diagnosed as having concomitant COPD and ABPA-CB. The patient was initiated on therapy for COPD along with oral corticosteroids, on which he had remarkable symptomatic improvement.

Gastric angiodysplasia in a hereditary hemorrhagic telangiectasia type 2 patient

Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal-dominantly inherited disease that occurs in approximately one in 5000 to 8000 people. Clinical diagnosis of HHT is made when a person presents three of the following four criteria: family history, recurrent nosebleeds, mucocutaneous telangiectasis, and arteriovenous malformations (AVM) in the brain, lung, liver and gastrointestinal (GI) tract. Although epistaxis is the most common presenting symptom, AVMs affecting the lungs, brain and GI tract provoke a more serious outcome. Heterozygous mutations in endoglin, activin receptor-like kinase 1 (ACVRL1; ALK1), and SMAD4, the genes involved in the transforming growth factor-β family signaling cascade, cause HHT. We report here the case of a 63 year-old male patient who presented melena and GI bleeding episodes, proven to be caused by bleeding from multiple gastric angiodysplasia. Esophagogastroduodenoscopy revealed multiple angiodysplasia throughout the stomach. Endoscopic argon plasma coagulation was performed to control bleeding from a gastric angiodysplasia. The patient has been admitted several times with episodes of hemoptysis and hematochezia. One year ago, the patient was hospitalized due to right-sided weakness, which was caused by left basal ganglia hemorrhage as the part of HHT presentation. In family history, the patient's mother and elder sister had died, due to intracranial hemorrhage, and his eldest son has been suffered from recurrent epistaxis for 20 years. A genetic study revealed a mutation in exon 3 of ALK1 (c.199C > T; p.Arg67Trp) in the proband and his eldest son presenting epistaxis.

10. A case of right middle lobe pulmonary arteriovenous malformation presenting as non-resolving pneumonia

Background Pulmonary arteriovenous malformations (PAVMs) are direct communications between the smaller pulmonary arteries and veins. These lesions allows blood to bypass the capillary system, flowing from arteries directly into veins. Case history The patient was a 51-year-old male, non-hypertensive, non-diabetic, asthmatic who came in due to recurrent episodes of haemoptysis. Initially this was treated as a case of pneumonia and/or pulmonary tuberculosis (PTB). A CT scan with contrast and CT angiogram were done and revealed AV malformation. He was referred to surgical service for elective thoracotomy and right middle lobe lobectomy. Histopathological findings showed lung tissue exhibiting areas of variably sized thin and partially thick vascular channels. The area was in close proximity to a bronchus and accompanying medium-sized arteries, predominantly extended to the pleural lining. Discussion The diagnosis of PAVM should be suspected in patients with any of the following presentations: (1) one or more pulmonary nodules associated with typical roentgenographic findings, (2) mucocutaneous telangiectases, and (3) unexplained findings such as dyspnoea, haemoptysis, hypoxaemia, polycythaemia, clubbing, cyanosis, cerebral embolism, or brain abscess. A practical approach would be to screen patients initially with chest radiograph, followed by shunt measurement by 100% oxygen. Our case was confirmed with PAVM by CT scan and CT angiogram and underwent right middle lobectomy. Other treatment options are embolisation and lungtransplantation. Conclusion The rarity of PAVMs and the variability of presentation posed a great challenge. Our case, in particular presenting as a non-resolving pneumonia with an unusual location, is a significant contribution to our registry. Its rarity should alert clinicians to include PAVMs in the differential diagnosis of patients with pneumonia and haemoptysis.

Idiopathic Pulmonary Hemosiderosis: A Case Report with Review of Related Literature

Pulmonary hemosiderosis is an uncommon disorder in pediatric population in developing countries. It may affect the lung in an isolated form of Idiopathic Pulmonary Hemosiderosis (IPH) or as a manifestation of systemic disorders. The present patient belonging to Mongolian race presented with history of fever, cough, respiratory distress and previous episode of hemoptysis. The child had anemia, negative tuberculin test and no acid-fast bacilli in sputum and presence of bilateral pulmonary infiltrates in X-ray chest. Sputum examination showed iron-laden macrophages and no secondary cause could be ascertained. The patient responded well to prednisolone treatment alone. Idiopathic pulmonary hemosiderosis can be diagnosed based on the clinical features and sputum examination. Lung biopsy and high resolution CT thorax may not be undertaken in setting where facilities are not available.

Cystic Lung Changes in a Thin Section CT in an Asymptomatic Young Adult with Unilateral Pulmonary Vein Atresia: A Case Report

Unilateral pulmonary vein atresia is a very rare congenital anomaly usually associated with high morbidity and mortality (1-4). Most of the patients reported were in infancy or early childhood with recurrent episodes of hemoptysis or pneumonia. Based on the gravity of symptoms, coil embolization and pneumonectomy are the usual forms of treatment (5, 6). There have been few radiologic reports about the findings of systemic collaterals to the pulmonary vessels such as interlobular septal thickening, ground-glass opacity and subpleural nodules (1, 2, 4, 7). We present the case of a 20-year-old male, who had been an asymptomatic pulmonary vein atresia and systemic-to-pulmonary collaterals patient. We observed cystic changes on right upper lobe of the lung, a rarely reported condition, and the septal thickenings, bronchovascular bundle thickening, and groundglass opacity which represent peripheral collaterals on thin section computed tomography (CT).