Severe Hemoptysis Research Articles

A PUZZLING CASE OF MYCOBACTERIAL LUNG DISEASE

SESSION TITLE: Chest Infections 4 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: There are over 150 species of mycobacteria that have been described to date. Pulmonary infections are most commonly due to Mycobacteria tuberculosis (MTB), however nontuberculous mycobacteria (NTM) are increasingly recognized worldwide, making microbial identification an important step in early management as drug treatment can vary significantly between species. CASE PRESENTATION: A 49-year-old male from Kenya presented with severe life-threatening hemoptysis, preceded by 4 days of productive cough and dyspnea. An urgent bronchoscopy identified active bleeding in the right upper lobe that was not amendable to endobronchial therapy. He subsequently underwent selective bronchial artery embolization, and the bleeding ceased. A CT chest revealed multiple cavitary lesions in both upper lobes. Bronchoalveolar lavage AFB smears returned positive. Based on these findings, he was started empirically on anti-tuberculous therapy, including rifampin, isoniazid, pyrazinamide and ethambutol. However, liquid medium culture grew within one week suggesting a rapidly growing mycobacterium as the likely causative microbe. At the same time, Nucleic Acid Amplification (NAA) tests for both MTB and Mycobacteria avium complex (MAC) returned negative. Therapy was hence switched to azithromycin, amikacin, and imipenem; levofloxacin was added due to ongoing suspicion for MTB. Other significant tests including HIV Antibody and Quantiferon gold were likewise negative. The patient responded to this regimen. After weeks of incubation, the AFB cultures confirmed MAC alone without a second organism. Antibiotics were ultimately switched to azithromycin, ethambutol and rifampin. DISCUSSION: This case presents a diagnostic challenge in that the patient’s rapidly growing culture and negative NAA test suggested against MAC. The clinical picture of a patient of Kenyan origin with hemoptysis and upper lobe lung disease, which is almost hallmark of MTB, further obscured the diagnosis. The significant overlap between the clinical disease manifested by various mycobacterial species makes NAA tests a particularly useful tool in guiding early treatment. They are highly accurate with a reported sensitivity and specificity of 95% and 98% in AFB-smear-positive respiratory specimens; this falls to 88% and 95% in smear-negative specimens. However, as highlighted by this case, clinicians must be vigilant of the statistical reliability of the NAA test. The false negative rate is 5% in smear positive disease, which is a small but non-negligible statistic, considering its treatment implicaitons. CONCLUSIONS: Diagnosis of mycobacterial lung disease requires microbiologic confirmation, and culture remains the gold standard test. NAA test serves as a reliable tool for rapid identification to guide early treatment. However, clinicians must be vigilant of the statistical reliability of the NAA test when adopting its use into clinical practice. Reference #1: https://academic.oup.com/cid/article/49/1/46/372207 Reference #2: http://jcm.asm.org/content/29/11/2473 Reference #3: https://academic.oup.com/cid/article/49/1/46/372207/Performance-of-Nucleic-Acid-Amplification-Tests DISCLOSURES: No relevant relationships by Yinn Shaung Ooi, source=Web Response

Dark and Deadly Down the Throat: Case Report of Acute Esophageal Necrosis

Acute Esophageal Necrosis (AEN) or, Black esophagus is a rare clinical pathology characterized as diffuse, circumferential, necrosis of esophageal mucosa mainly in the distal part of esophagus detected with esophagogastroduodenoscopy (EGD). It's usually associated with multiorgan dysfunction with high mortality rate of 30%. A 61 years-old Male with the history of DM-II, Hypothyroidism, and Duodenal perforation transported from the nursing home with accidental extrication of PEG. Six months prior to admission, patient had history of duodenal ulcer, complicated with Sepsis transpiring to undergo tracheostomy and PEG placement. Vital signs were within normal limits. On examination, abdomen was non-distended with no stigmata of secretions or blood from patent PEG tube-insertion site. Initial investigations showed BUN 54 mg/dl with creatinine 0.9 mg/dl, hemoglobin 10.9 g/dl, leukocytosis (29.4 K/mm3) with bandemia (11% of WBC count), and INR 1.1, Hypoalbuminemia (2.4 g/dl) was noted along with elevated alkaline phosphatase (84 IU/L) and Alanine Aspartate (61 U/L). Patient was started on crystalloid fluids, broad-spectrum antibiotics for presumptive diagnosis of aspiration pneumonia as the chest X-ray showed infiltrate, and intravenous pantoprazole drip. Patient's vital signs remained stable along with hemoglobin ranging above 9 g/dl, was scheduled for Esophagogastroduodenoscopy (EGD). EGD showed severe esophagitis with diffuse dark mucosal discoloration, erosion and profound ulceration in entire esophagus suggestive of ischemic necrosis, this rare condition is known as Black Esophagus (Acute Esophageal Necrosis), next day patient developed severe hemoptysis leading to cardiac arrest, unfortunately patient didn't survive. This case illustrates patients with average age of 65 years old with multiple co-morbidities, such as diabetes or respiratory failure presenting with hematemesis, AEN should be part of differential diagnosis until endoscopic evaluation completes. Treatment consists of supportive therapy with initial management consists of intravenous hydration, correcting anemia with packed red blood cell transfusion, nil-per-os, and proton-pump inhibitor.1819_A Figure 1. Endoscopic view showing middle third of esophagus with severe mucosal changes with erosion and beginning of ischemic changes1819_B Figure 2. Lower third of the esophagus with diffuse circumferential black necrotic mucosa

P3.01-48 The Efficiency of Low-Dose Apatinib in Treatment of Advanced Lung Squamous Cell Carcinoma

Chemotherapy is the main treatment for advanced lung squamous cell carcinoma(LSCC) patients due to lack of effective targeted agents. Previous studies proved that apatinib, which is an antiangiogenic and small-molecule targeted drug, showed clinical benefit in patients with advanced non-squamous non-small cell lung cancer. In this study, we assessed the efficacy and safety of low-dose (125mg or 250mg, QD, oral) apatinib in the treatment of advanced LSCC. A total of 8 advanced LSCC patients clinical data were reviewed retrospectively including 1 patient treated only by apatinib and 7 patients combined with other anti-tumor therapies (i.e., bronchial artery embolization (BAE), chemotherapy, radiotherapy or surgery) between May 2016 to July 2017. Efficacy was evaluated with the RECIST version 1.1 and adverse effects (AEs) were graded using the NCI CTC version 4.0. One SD and 7 PR were confirmed, resulting in an objective response rate of 87.5% (7/8) and a disease control rate of 100% (8/8), respectively. The median progression-free survival (PFS) was 197 days (95% CI, 122-272 days), and the median overall survival (OS) was 252 days (95% CI,161-342 days). Both PFS and OS were 93 days for the patient with monotherapy, while the median PFS and median OS were 212 days (95% CI, 132-292 days) and 274 days (95% CI,182-366 days), respectively for the 7 patients with combined treatment. Patients with grade 3 or 4 AEs included 2 hemoptysis, 1 leukopenia and 1 fatigue. Patients characteristics are shown in the table. Low-dose apatinib combined with BAE, chemotherapy, radiotherapy or surgery is effective and well tolerated in advanced LSCC patients. Risk of massive hemoptysis should be considered in LSCC patients treated with apatinib alone. BAE or radiotherapy may play a role in the prevention and treatment of severe hemoptysis associated with apatinib.Further prospective studies with larger numbers of patients are required.

Swimming-induced pulmonary edema: current perspectives.

With the growing popularity of water-based sports, cases of swimming-induced pulmonary edema (SIPE) are becoming increasingly recognized. SIPE, a potentially life-threatening condition, is an acute cause of breathlessness in athletes. It has been described frequently in scuba divers, swimmers, and triathletes and is characterized by symptoms and signs of pulmonary edema following water immersion. It is important to recognize that athletes’ symptoms can present with a spectrum of severity from mild breathlessness to severe dyspnea, hemoptysis, and hypoxia. In most cases, there is rapid resolution of symptoms within 48 hours of exiting the water. Recent advances in the understanding of the pathophysiology of SIPE, particularly regarding exaggerated pulmonary vascular pressures, have begun to explain this elusive condition more clearly and to distinguish its predisposing factors. It is essential that event organizers and athletes are aware of SIPE. Prompt recognition is required not only to prevent drowning, but also to implement appropriate medical management and subsequent advice regarding return to swimming and the risk of recurrence. This manuscript provides a current perspective on SIPE regarding the incidence rate, the current understanding of the pathophysiology, clinical presentation, medical management, recurrence rates, and advice on return to sport.

Partial laryngotracheal resection and anastomosis, institutional 10 years\u2019 experience

ObjectiveThis study aimed to evaluate the results of partial laryngotracheal resection and anastomosis in the management of iatrogenic laryngotracheal stenosis.Patients and MethodsThis retrospective analytical study was conducted on all patients who had been operated by means of partial laryngotracheal resection and anastomosis in our institute, from 2004 to 2014. The period of follow-up was at least 1 year. The total number of the patients included was 22.ResultsSuccessful decanulation was achieved in 20 (90.9%) cases. The number of complicated cases in our study (with one or more complication) was eight (36.3%). Two cases complained of dyspnea with documented restenosis of the trachea, and one case died from severe hemoptysis at 12 days postoperatively, most probably from trauma of the innominate. Two cases were complicated by surgical emphysema and one case was complicated by hematoma; all of them were managed successfully.ConclusionPartial laryngotracheal resection and anastomosis is a safe and reliable surgical method for the management of grade III and IV iatrogenic laryngotracheal stenosis. This technique achieves best results in male patients when the stenosis is short segment, and not involving the cricoid cartilage.

Health seeking behaviour in pulmonary tuberculosis: a cross sectional study

Background: Health seeking behaviour has been identified as a complex and dynamic process which influences disease burden of tuberculosis. The present study aimed to study health seeking behaviour among pulmonary tuberculosis patients in a metropolitan city and to assess diagnostic and treatment delays and their determinants.Methods: A cross sectional study was conducted among newly diagnosed pulmonary tuberculosis patients registered for intensive phase of Category 1 ATT during the study period in Zone VIII of Chennai Corporation. The sample size was 197. The study was conducted over a period of one year from September 2015 to August 2016. A standardized WHO interview schedule on diagnostic delay was used for the study.Results: Patients sought healthcare for more severe symptoms like hemoptysis (delay of 38 days) earlier than for cough (delay o- 8 days). Other reasons for delay in seeking care were hope of self-resolution, financial constraints, fear of what the diagnosis would be, incompatible timings etcetera. The total mean delay from onset of symptoms till start of treatment was around 47 days, out of which the patient delay was 42 days. Factors significantly associated with delay included smoking, age more than 35 years and not approaching healthcare facilities first.Conclusions: An unacceptably high patient delay is the major contributor to total delay in the diagnosis and treatment of pulmonary tuberculosis patients. There is increased odds of delay among smokers compared to those who have never smoked. So smokers may be added to the high risk group for suspicion of tuberculosis for fast tracking of diagnosis and treatment. Furthermore, methods to curb over the counter medications should be explored.

Case 1: Hemoptysis, Hypoxia, and Anemia in a 10-year-old Girl

1. Tony Tarchichi, MD* 2. Kathryn Lupo, MD* 1. *Diagnostic Referral Group, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA A 10-year-old premenarchal girl with a history of chromosome 16 short arm duplication, seizures, and global developmental delay is transferred to us from another hospital for evaluation of new-onset severe anemia, hypoxia, and hemoptysis. At an outside hospital, her heart rate was 140 beats/min, blood pressure was 160/80 mm Hg, and oxygen saturation level was 88% on room air (100% on nonrebreather oxygen supplementation), and she was afebrile. There was no obvious bleeding source on examination. Laboratory evaluation revealed a hemoglobin level of 6.4 g/dL (64 g/L) compared with 13.2 g/dL (132 g/L) 3 years earlier. Chest radiography revealed bilateral diffuse infiltrates. She was transferred to our hospital. On admission to our hospital, the patient’s mother reports that the patient is acting more aggressive than usual and appears pale. Two weeks before admission she had a brief episode of mild upper respiratory tract symptoms without fever. The review of systems is otherwise negative, including no history of weight loss, hematochezia, black tarry stool, epistaxis, bruising/bleeding, scleral icterus, jaundice, or hematuria. Vital signs on hospital admission are as follows: temperature, 98.8°F (37.1°C); heart rate, 98 to 137 beats/min; respiratory rate, 22 to 36 breaths/min; and blood pressure, 96 to 120/47 to 89 mm Hg. Her oxygen saturation level is 80% on room air and increases to 100% on 100% nonrebreather mask. She is not …

Severe thrombocytopenia and intracranial hemorrhage: Unusual presentation of tuberculosis

BackgroundAlthough various hematologic abnormalities are seen in tuberculosis (TB), severe thrombocytopenia is a rare event.Case presentationWe report a case of a 26-year-old female patient who presented with severe thrombocytopenia-induced hemoptysis, macroscopic hematuria, and intracranial hemorrhage. The patient was found to have clinical, microbiological, and histopathological evidence of TB. The thrombocytopenia was successfully treated with anti-TB drugs.ConclusionSevere thrombocytopenia can be one of the hematological manifestations of TB that is successfully treated with anti-TB drugs.

Recurrent Hemoptysis in Patient with Primary Pulmonary Hypertension – A Case Report and Literature Review

Pulmonary hypertension (PH) is defned as an increase in mean pulmonary arterial pressure (mPAP) ≥ 25 mmHg at rest as assessed by right heart catheterization (RHC). The symptoms of PH are non-specifc and mainly related to progressive right ventricular (RV) dysfunction. In some patients the clinical presentation may be related to mechanical complications of PH andthe abnormal distribution of blood flow in the pulmonary vascular bed, include hemoptysis related to rupture of hypertrophied bronchial arteries. Hemoptysis is a serious complication that is rarely reported in patients with pulmonary arterial hypertension (PAH). Hemoptysis severity ranges from mild to very severe leading tosudden death. Hemoptysis are reported to be a terminal stage ofa complication due to PAH with prevalence is variable, from 1% to 6%. Although the incidence is quite rare, the presence of recurrent hemoptysis in patients with pulmonary hypertension is a sign of poor prognosis. Bronchial artery embolization is suggested as an acute emergency procedure in the case of severe hemoptysis or as elective intervention in cases of frequent mild or moderate episodes.

Risk factors for haemoptysis after percutaneous transthoracic needle biopsies in 4,172 cases: Focusing on the effects of enlarged main pulmonary artery diameter.

To evaluate the risk factors for haemoptysis after cone-beam computed tomography (CBCT)-guided percutaneous transthoracic needle biopsy (PTNB), particularly on whether the enlargement of main pulmonary artery diameter (mPAD) is a risk factor for PTNB-related haemoptysis. 4,172 cases of CBCT-guided PTNBs in 3,840 patients were retrospectively included in this study. Various data including mPAD measured on preprocedural CT images were evaluated using logistic regression analyses to determine significant risk factors for both haemoptysis and severe haemoptysis, designated as when blood transfusion, vascular embolisation or cardiopulmonary resuscitation were required to manage patients with haemoptysis. Haemoptysis occurred in 5.78 % (241/4172) of all PTNB procedures, while severe haemoptysis occurred in 0.18 % (7/4172). Female sex, history of antiplatelet or anticoagulative drugs, prolonged activated partial thromboplastin time, subsolid nodules, cavitary nodules and long pleura-to-target distance were revealed to be independent risk factors for haemoptysis, while mPAD enlargement (> 29.5 mm) was not. Regarding severe haemoptysis, however, mPAD enlargement was demonstrated to be an independent risk factor along with the presence of subsolid and cavitary target nodules. mPAD enlargement was not a significant risk factor for PTNB-related haemoptysis; however, it was a significant risk factor for severe haemoptysis. • mPAD enlargement was a significant risk factor for severe PTNB-related haemoptysis. • mPAD can be useful in screening high-risk patients for severe haemoptysis. • Subsolid or cavitary nodule was another significant risk factor for severe haemoptysis.

Severe Hemoptysis Associated with Bacterial Pulmonary Infection: Clinical Features, Significance of Parenchymal Necrosis, and Outcome.

Severe hemoptysis (SH) associated with non-tuberculosis bacterial lower respiratory tract infection (LRTI) is poorly described, and the efficacy of the usual decision-making process is unknown. This study aimed at describing the clinical, radiological patterns, mechanism, and microbiological spectrum of SH related to bacterial LRTI, and assessing whether the severity of hemoptysis and the results of usual therapeutic strategy are influenced by the presence of parenchymal necrosis. A single-center analysis of patients with SH related to bacterial LRTI from a prospective registry of consecutive patients with SH admitted to the intensive care unit of a tertiary referral center between November 1996 and May 2013. Of 1504 patients with SH during the study period, 65 (4.3%) had SH related to bacterial LRTI, including non-necrotizing infections (n=31), necrotizing pneumonia (n=23), pulmonary abscess (n=10), and excavated nodule (n=1). The presence of parenchymal necrosis (n=34, 52%) was associated with a more abundant bleeding (volume: 200ml [70-300] vs. 80ml [30-170]; p=0.01) and a more frequent need for endovascular procedure (26/34; 76% vs. 9/31; 29%; p<0.001). Additionally, in case of parenchymal necrosis, the pulmonary artery vasculature was involved in 16 patients (47%), and the failure rate of endovascular treatment was up to 25% despite multiple procedures. Bacterial LRTI is a rare cause of SH. The presence of parenchymal necrosis is more likely associated with bleeding severity, pulmonary vasculature involvement, and endovascular treatment failure.

Granulomatosis with polyangiitis: seeing the diagnosis

A 41-year-old woman presented to her primary doctor with nausea, back pain and lower extremity oedema. Initial labs showed elevated serum creatinine and white blood cell count (WBC), which her...

A child with recurrent pallor and hemoptysis: Diagnostic challenges

A 7-year-old girl presented with severe pallor, cough, and massive hemoptysis. She had been previously hospitalized twice within the time span of 2 years for severe pallor and hemoptysis, each time requiring 2U of blood transfusion. In the recent episode, blood examination was suggestive of iron deficiency anemia, chest radiograph yielded bilateral pulmonary infiltrate, computed tomography scan of lungs showed ground glass pattern, and bronchoalveolar lavage revealed hemosiderin-laden macrophages. Investigations to exclude any secondary causes of pulmonary hemosiderosis were negative. The child was diagnosed as a case of idiopathic pulmonary hemosiderosis and treated with prednisolone.

Coil therapy for patients with severe emphysema and bilateral incomplete fissures - effectiveness and complications after 1-year follow-up: a single-center experience.

BackgroundLung volume reduction coil (LVRC) treatment is established in daily endoscopic lung volume reduction routine. The aim of this study was to evaluate the safety and efficacy of LVRC treatment.Patients and methodsThis was a retrospective analysis of 86 patients (male/female: 40/46, mean age: 64±7 years) with severe COPD and bilateral incomplete fissures. A total of 10 coils were unilaterally implanted in a single lobe, and 28 out of 86 patients were treated bilaterally. At 90-, 180-, and 365-day follow-up, changes in pulmonary function test (PFT), 6-minute walk test (6MWT) and modified Medical Research Council (mMRC) dyspnea scale, as well as possible complications, were recorded.ResultsAt 90 days, the forced expiratory volume in 1 second did improve (P<0.001), but the improvement was not sustained at the 180- and 365-day follow-up (baseline: 0.71±0.21 vs 0.77±0.23 vs 0.73±0.22 vs 0.70±0.18 L). Both vital capacity and residual volume improved significantly (P<0.001) at the 90- and 180-day follow-up, but the improvement was lost after 365 days. Total lung capacity decreased at the 90-day follow-up but returned to baseline values at the 180- and 365-day follow-up. 6MWT (P=0.01) and mMRC (P=0.007) also improved at 90 and 180 days (Δ6MWT of 31±54 and 20±60 m, respectively), but the improvement was also lost at the 365-day follow-up. No significant further improvement was evident at any point in the follow-up after the second procedure. A total of 4 out of 86 patients passed away due to complications. Significant complications in the first 3 months and then at 12 months included the following: severe hemoptysis in 4 (3.5%) and 4 (3.5%) patients, pneumonia requiring hospitalization in 32 (28.1%) and 9 (7.9%) patients and pneumothorax in 7 (6.1%) and 2 (1.7%) patients, respectively. Milder adverse events included self-limited hemoptysis, pneumonias, or COPD exacerbations treated orally.ConclusionLVRC improved PFT, 6MWT and mMRC initially, but the improvement was lost after 365 days. Furthermore, we observed 4 deaths and significant severe complications, which need to be further elucidated.

Etiology and outcome of moderate-to-massive hemoptysis: Experience from a tertiary care center of North India.

The aim of this study was to evaluate the etiology of hemoptysis in patients presenting to emergency department of Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Prospectively 110 patients presenting to the emergency department with history of hemoptysis were screened for a period of one and half years. Out of these, 64 patients having true hemoptysis were enrolled in the study. The patients were clinically evaluated with detailed history. Radiological evaluation included chest x rays and computerized tomogram. Sputum examination and bronchoscopy was done to establish the etiology. All the patients were conservatively managed using intravenous fluids, antibiotics, anti-tussive and anti-fibrinolytic drugs. Bronchial/pulmonary artery embolization was performed for controlling ongoing bleeding/re-bleeding. All the patients were followed up till discharge or death. The mean age was 41.8 ± 15.16 years with male preponderance. Pulmonary tuberculosis (active/ sequel) was the most common etiology (65%), followed by community acquired pneumonia (10.93%), bronchiectasis (9.3%), carcinoma lung (7.18%) and miscellaneous causes (8.6%). Almost all patients (98%) had severe hemoptysis (>100 ml in 24 hours). Abnormalities in bronchial circulation were present in 59.4% and 14% of patients had pulmonary circulation abnormalities. 65% patients responded to conservative treatment. 23.4% patients under went intervention out of which 73.3% underwent bronchial artery embolization (BAE) and remaining 26.6% underwent pulmonary artery embolization (PAE). One patient died during hospital stay due to necrotizing pneumonia and another left hospital against medical advice (outcome unknown). TB (active/sequel) remains the most common cause of hemoptysis in patients admitted in emergency department. Non-TB causes like primary bronchiectasis, carcinoma lung and pneumonia are other important causes. Conservative management suffices in majority patients for controlling active bleed.

Approach to Hemoptysis in the Modern Era.

Hemoptysis is a frequent manifestation of a wide variety of diseases, with mild to life-threatening presentations. The diagnostic workup and the management of severe hemoptysis are often challenging. Advances in endoscopic techniques have led to different new therapeutic approaches. Cold saline, vasoconstrictive and antifibrinolytic agents, oxidized regenerated cellulose, biocompatible glue, laser photocoagulation, argon plasma coagulation, and endobronchial stents and valves are amongst the tools available to the bronchoscopist. In this article, we review the evidence regarding the definition, etiology, diagnostic modalities, and treatment of severe hemoptysis in the modern era with emphasis on bronchoscopic techniques.

Predictores de mortalidad en pacientes con hemoptisis en un servicio de emergencia

Introducción. La hemoptisis es una de las manifestaciones más alarmantes de las enfermedades broncopulmonares y representa el 7% de los ingresos hospitalarios a los servicios de medicina Interna. La hemoptisis severa está relacionada a cifras altas de mortalidad alrededor del 40%. Existen múltiples factores que cuando coexisten con hemoptisis alteran su evolución y pronóstico. No solo la severidad de la hemoptisis determina el riesgo de muerte, sino la presencia de comorbilidades, especialmente pulmonares que afectan la reserva funcional del paciente. Objetivos. Determinar la mortalidad y los factores que incrementan la mortalidad en pacientes con hemoptisis que son admitidos por un servicio de emergencia. Diseño. Estudio analítico. Institución. Servicio de emergencia, Hospital Nacional Dos de Mayo, Lima, Perú. Participantes. Pacientes con diagnóstico de hemoptisis. Métodos. Se revisaron 108 historias clínicas de pacientes que fueron hospitalizados por emergencia con diagnóstico de hemoptisis en un lapso de 2 años. Se recolectaron las variables edad, sexo, procedencia, presencia de comorbilidades, reserva funcional respiratoria cualitativa, entre otros. Los resultados se expresaron en distribución de frecuencias absolutas y relativas, medias (+1DE); los factores relacionados a incremento de mortalidad se les determinó mediante el estimado del riesgo relativo (RR). Para la comparación de proporciones se utilizó la prueba chi2. Para determinar las variables asociadas a mortalidad se usó el modelo de regresión logística múltiple. Principales medidas de resultados. Factores asociados a incremento de mortalidad. Resultados. Los factores asociados a incremento de mortalidad fueron la presencia de caverna mayor de 1 cm de diámetro, de localización hiliar, y el antecedente de readmisiones por hemoptisis. Así mismo, la presencia de fibrosis pulmonar que comprometía más de 50% del parénquima pulmonar bilateral fue importante predictor de mortalidad. Conclusiones. La reserva funcional pulmonar fue el determinante principal relacionado a mortalidad en pacientes con hemoptisis que fueron hospitalizados por emergencia.

BMPR2 mutation status influences bronchial vascular changes in pulmonary arterial hypertension.

The impact of bone morphogenetic protein receptor 2 (BMPR2) gene mutations on vascular remodelling in pulmonary arterial hypertension (PAH) is unknown. We sought to identify a histological profile of BMPR2 mutation carriers.Clinical data and lung histology from 44 PAH patients were subjected to systematic analysis and morphometry.Bronchial artery hypertrophy/dilatation and bronchial angiogenesis, as well as muscular remodelling of septal veins were significantly increased in PAH lungs carrying BMPR2 mutations. We found that patients displaying increased bronchial artery remodelling and bronchial microvessel density, irrespective of the mutation status, were more likely to suffer from severe haemoptysis. History of substantial haemoptysis (>50 mL) was significantly more frequent in BMPR2 mutation carriers. 43.5% of BMPR2 mutation carriers, as opposed to 9.5% of noncarriers, displayed singular large fibrovascular lesions, which appear to be closely related to the systemic lung vasculature.Our analysis provides evidence for the involvement of the pulmonary systemic circulation in BMPR2 mutation-related PAH. We show that BMPR2 mutation carriers are more prone to haemoptysis and that haemoptysis is closely correlated to bronchial arterial remodelling and angiogenesis; in turn, pronounced changes in the systemic vasculature correlate with increased pulmonary venous remodelling, creating a distinctive profile in PAH patients harbouring a BMPR2 mutation.

Glue in Hemoptysis.

Glue in Hemoptysis.

A Rare Cause of Massive Hemoptysis: Bilateral Endobronchial Lesions Secondary to Metastatic Gestational Choriocarcinoma in a Post-Menopausal Woman

Massive hemoptysis is a challenge in the patient with neoplastic lung disease due to its high mortality and the demand of a multidisciplinary approach. Its management entails intensive care, interventional pulmonology, hemodynamics, radiology and surgery. We present the case of a patient with obstructive endobronchial lesions and severe hemoptysis diagnosed as metastatic gestational choriocarcinoma, who was successfully treated with endoscopic intervention and chemotherapy.