Recurrent Episodes Of Hemoptysis Research Articles

De novo thoracic endometriosis in a menopausal women

Endometriosis is very common in reproductive age group. Since it is an estrogen dependent problem it is generally believed that it denotes “active ovarian function” and is “healed” after menopause. Most commonly endometrial tissue is found in ovaries resulting in the formation of chocolate cysts but it can also be found in extrapelvic sites. In this case report we will discuss endometriosis after menopause. Pulmonary endometriosis is a rare form of thoracic endometriosis. We describe a case of a 54-year-old woman with surgical menopause with recurrent episodes of haemoptysis, chest pain and dyspnea. Her Chest CT revealed multiple small pulmonary nodules. Biopsy from left lung lesion suggested endometriosis.

LIVING WITH EHLERS-DANLOS SYNDROME: FOLLOWING A YOUNG BOY THROUGH HIS UPS AND DOWNS ON HIS JOURNEY INTO ADULTHOOD

LIVING WITH EHLERS-DANLOS SYNDROME: FOLLOWING A YOUNG BOY THROUGH HIS UPS AND DOWNS ON HIS JOURNEY INTO ADULTHOOD

A voluminous tumour of the tracheal bifurcation.

The tracheal bifurcation is the point at which the trachea splits into the left and right main stem bronchus conducting to the lungs. Primary tumours of the tracheal bifurcation are rare. We report images of an adenoid cystic carcinoma of the tracheal bifurcation diagnosed accidentally following recurrent episodes of haemoptysis

Hemitruncus derecho en la edad adulta: Un hallazgo poco usual

El hemitruncus arterioso es una cardiopatía congénita rara caracterizada por el origen anómalo de alguna de las ramas de la arteria pulmonar a partir de la aorta ascendente. En la mayoría de los casos su diagnóstico se realiza durante la infancia; además, por su elevada morbimortalidad es extremadamente inusual su evolución asintomática y supervivencia hasta la etapa adulta. Presentamos el caso de un varón de 30 años con antecedente de cierre quirúrgico de persistencia del conducto arterioso en la infancia, que cursó asintomático hasta hace un año, y se le diagnosticó hemitruncus arterioso a partir de episodios recurrentes de hemoptisis.

Tuberculosis-induced cartilage fractures leading to collapse of the left main stem bronchus

A 94-year-old female patient was referred to the emergency department of our hospital for cough productive of purulent sputum and recurrent episodes of haemoptysis. She was a mild, former smoker....

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.

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,...

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.

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.

Idiopathic Pulmonary Hemosiderosis in an Adult with Unusual Radiologic Features

ABSTRACT Idiopathic pulmonary hemosiderosis is an exceptionally rare cause of diffuse alveolar hemorrhage that occurs primarily in infants and children. Few cases are reported in adults. Patients usually present with recurrent episodes of hemoptysis, fatigue breathlessness and severe anemia with asymptomatic periods in between. Our patient, who was diagnosed with idiopathic pulmonary hemosiderosis demonstrated diffuse ground glass opacity, focal centrilobular emphysema and multiple sub pleural cysts and few parenchymal cysts during acute episode of hemoptysis. Unusual findings in our case were sub pleural cysts, parenchymal cysts and focal centrilobular emphysema which was not documented in any case reports of idiopathic pulmonary hemosiderosis cases to that of our knowledge. How to cite this article Kasilingam SK, Prashanth S, Govindagoudar MB, Devaramani B, Swamygowda CC. Idiopathic Pulmonary Hemosiderosis in an Adult with Unusual Radiologic Features. J Postgrad Med Edu Res 2014;48(4):199-200.

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.

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).

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.

Supernumerary, ectopic tooth in the maxillary antrum presenting with recurrent haemoptysis

BackgroundEctopic eruption of teeth in non-dental sites is a rare phenomenon and can present in a variety of ways such as chronic or recurrent sinusitis, sepsis, nasolacrimal duct obstruction, headaches, ostiomeatal complex disease and facial numbness. However, presentation of such patients with recurrent haemoptysis has not been described in the literature so far. We have described a case of an ectopic, supernumerary molar tooth in the maxillary antrum in a patient who initially presented with haemoptysis.Case presentationA 45-year-old male presented with a 2-month history of episodic haemoptysis. A pedunculated growth from the inferior nasal turbinate was seen with fibre-optic visualization. Although the patient was empirically started on antibiotic and anti-allergic therapy, there was no improvement after a few weeks and the patient had recurrent episodes of haemoptysis. Fibre-optic visualization was repeated showing bilateral osteomeatal erythema. Computed tomography scan of the paranasal sinuses demonstrated complete opacification of the left maxillary antrum along with a focal area of density comparable to bone. An ectopic, supernumerary molar tooth was found in the left maxillary antrum on endoscopic examination and subsequently removed. In addition, copious purulent discharge was seen. Post-operatively, the patient was treated with a 10-day course of oral amoxicillin-clavulanate. On follow-up, he reported resolution of symptoms.ConclusionRecurrent haemoptysis has not been described as a presentation for a supernumerary, ectopic tooth in literature before. We recommend that in patients with sinusitis-type of opacification of maxillary antrum and whose condition is refractory to conventional medical treatment, consideration should be given to the investigation of possible underlying anomalies as the cause of such symptoms. Presence of foreign bodies and ectopic teeth in paranasal sinuses can be reliably excluded with the use of appropriate radiological imaging and endoscopic examination.

Hemoptysis Requiring Bronchial Artery Embolization in Pulmonary Arterial Hypertension

Hemoptysis is an uncommon complication in patients with pulmonary arterial hypertension (PAH). Although the mechanism of hemoptysis is unknown, treatment with bronchial artery embolization (BAE) is proposed to be a safe and reliable method of treatment. We report our experience in treating PAH patients presenting with acute hemoptysis that required multiple BAEs. Three female and one male PAH patients, ages 45 + or - 9 years (mean + or - standard deviation [SD]) presented with acute hemoptysis. Right ventricular systolic pressure and cardiac index at the time of the first episode of hemoptysis were 85 + or - 17 mm Hg and 2.7 + or - 0.7 L/min/m, respectively. Two of the four patients had recurrent episodes of hemoptysis, requiring multiple BAEs. All four were on intravenous prostacyclin analogue. None were receiving warfarin or endothelin receptor antagonists at the time of the episode. During each episode of hemoptysis, international normalized ratio (INR) was 1.09 + or - 0.11 units, and platelet count was 124,000 + or - 47,000 per microliter. Each episode of hemoptysis was acutely terminated with BAE. In the majority of cases, patients had multiple aberrant bronchial arteries embolized, and an average of 2.3 arteries was embolized per session (1-4 embolized arteries). Each BAE was performed utilizing polyvinyl alcohol particles, ranging from 250-500 microns. There were no reported complications of the 14 BAE procedures performed. Although the incidence of hemoptysis is unknown and likely underreported, we report our experience in which recurrent hemoptysis was treated with multiple BAE procedures. This report emphasizes the efficacy and safety of BAE in terminating episodes of recurrent hemoptysis in patients with severe PAH.

Hemorrhage from a cavernous hemangioma with fatal blood aspiration: A rare cause of sudden unexpected death

Blood aspiration may be fatal, even when caused by a minor hemorrhage, and then it is important to localize and identify the source of bleeding in order to determine its origin as traumatic, spontaneous or iatrogenic. The present case deals with the clinically unexpected sudden death of a 73-year-old woman who underwent pulmonary artery catheterization (PAC) 11 days before because of known pulmonary hypertension. The forensic autopsy revealed a previously undiagnosed cavernous hemangioma of the right lung which had led to a local intrapulmonary hemorrhage with secondary bleeding into the bronchial tree. The fatal blood aspiration was preceded by recurrent episodes of hemoptysis, and its occurrence was probably promoted by the pre-existing pulmonary hypertension. The present case and other reports in the medical literature suggest that vessel malformations of the lung have to be considered as a potential cause of unexpected sudden death. Careful investigation is needed for post-mortem identification of the bleeding site.

Idiopathic pulmonary hemosiderosis in a 9-year-old girl

Diffuse alveolar hemorrhage (DAH) is a rare and life-threatening condition characterized by hemoptysis, dyspnoea, alveolar infiltrates on chest radiograph and various degrees of anemia. It may occur either as a primary disease of the lungs or a secondary condition due to cardiac, systemic vascular, collagen or renal diseases. Idiopathic pulmonary hemosiderosis (IPH) is a separate form of DAH of unknown origin, associated in some cases with celiac disease. The estimated incidence of IPH in children is 0.24-1.23 cases per million, with a mortality rate as high as 50%. Only about 500 cases of this disease have been described in medical literature. We present a case of a 9-year-old girl diagnosed with IPH, which was confirmed by the presence of many hemosiderin-laden macrophages in bronchoalveolar lavage obtained by bronchofiberoscopy. Therapy with glucocorticoids was initiated with a partial and transient response. Azathioprine and a gluten-free diet were subsequently introduced. However, the girl still suffers from recurrent episodes of hemoptysis, dyspnea and anemia.

A case of idiopathic pulmonary hemosiderosis with seasonal recurrence

Idiopathic pulmonary hemosiderosis (IPH) is a rare disease affecting mostly children. This disorder is characterized by recurrent episodes of hemoptysis, bilateral diffuse pulmonary infiltrates, and iron-deficiency anemia. An acute fulminant alveolar hemorrhage can be fatal due to respiratory failure, while chronic hemorrhage leads to hemosiderin-laden macrophages and pulmonary fibrosis. Genetic, autoimmune, allergic, environmental, and metabolic mechanisms of pathogenesis have been suggested, but the etiology of IPH remains unknown. We report on a 9-year-old girl with idiopathic pulmonary hemosiderosis who showed seasonal recurrences without cause.

Atresia congénita unilateral de las venas pulmonares: hallazgos radiológicos

Congenital unilateral pulmonary vein atresia is a very rare anomaly that generally presents during childhood or adolescence as recurrent episodes of pulmonary infections or hemoptysis. Its presentation in adults is highly exceptional. We describe two patients with congenital unilateral pulmonary vein atresia: the first is a 26-year-old woman with recurrent episodes of hemoptysis, and the second is a three-year-old boy with a history of bronchospasm and recurrent pneumonia from the age of three months. Although the diagnosis has classically been reached using cardiac catheterization and pulmonary angiography, we think that the CT and MRI findings can enable the diagnosis of congenital unilateral pulmonary vein atresia in cases with compatible clinical presentation. We emphasize the capacity of MRI for characterizing the vascular anomaly present in these patients.

Unusual Case of Hemoptysis 13 Years After Bilobectomy

We describe a 68-year-old man with recurrent episodes of hemoptysis. The patient had undergone right upper and middle lobectomies for a benign cystic lesion 13 years ago and coronary artery bypass grafting for ischemic heart disease immediately before the onset of hemoptysis. Diagnostic work-up revealed that pulmonary arterial flow to the remaining right lower lobe had been inadvertently compromised by prior ligation of the right main pulmonary artery during the time of his bilobectomy, with the development of a robust collateral blood supply derived from bronchial and intercostals arteries. Successful treatment required percutaneous embolization of the dominant bronchial collaterals, followed by completion pneumonectomy.