Hemoptysis

Nous rapportons l’observation d’un homme de 68 ans qui avait consulté pour dyspnée et hémoptysie. La fibroscopie bronchique avait montré une formation bourgeonnante au niveau du versant postérieur de la carène. Des biopsies bronchiques étagées étaient réalisées et avaient conclu à une amylose de type AL. L’amylose trachéobronchique localisée est une affection très rare, pouvant simuler une tumeur bronchique surtout lorsqu’elle survient chez un sujet de sexe masculin et tabagique.The authors report the case of a 68-year-old man complaining of haemoptysis and breathlessness. Bronchoscopy revealed a budding formation in tracheal bifurcation. Multiple biopsies were performed and concluded as to AL type amyloidosis. Tracheobronchial amyloidosis is an uncommon localised form of amyloidosis that can simulate lung cancer.

Catamenial hemoptysis is a rare condition that is associated with the presence of intrapulmonary or endobronchial endometrial tissue. We describe a case of endobronchial endometriosis with catamenial hemoptysis. The patient was a 22 years-old girl presented with recurrent hemoptysis episodes for the last two years. Bronchoscopic examination was performed within first days of menses, and indicated multiple purplish-red submucosal patches in distal one third of trachea and bilateral bronchial trees that bled easily when touched. The cytological evaluation of the bronchial brushing specimens demonstrated clusters of small cuboidal cells consistent with an endometrial origin. Follow-up bronchoscopic examination at the end of the menstrual cycle revealed that the previous tracheobronchial lesions disappeared. The patient was treated with Gonadotropin-Releasing Hormone (GnRH) analogues and hormones including estrogen and progesterone therapy. Recurrent hemoptysis stopped following the med...

Pulmonary arteriovenous fistulas (PAVFs) are rare vascular malformations of the lung. There is a strong association with Rendu-Osler-Weber disease. Although most patients are asymptomatic, PAVFs can cause dyspnea from a right-to-left shunt. They can also bleed and result in hemoptysis and hemothorax. Because of paradoxical emboli, various central nervous system complications have been described including stroke, and brain abscess. Currently, spiral computed tomography offers the most practical method for establishing the presence of PAVFs. Most patients should be treated. Therapeutic options include angiographic embolization with metal coils or balloon occlusion and surgical excision. Angiographic treatment has become the mainstay of therapy for most patients during the last decade. It is less invasive and can be repeated easily. Surgery, which usually consists of a conservative lung resection, is associated with low morbidity and a low recurrence rate. Both therapeutic approaches are discussed. The Mayo Clinic surgical experience of the last 20 years for PAVFs is presented.

After repetitive deep dives, breath-hold divers are often affected by a syndrome characterized by typical symptoms such as cough, sensation of chest constriction, blood-striated expectorate (hemoptysis) and, rarely, an overt acute pulmonary edema syndrome, often together with various degrees of dyspnea. The aim of this work is an epidemiological investigation to evaluate the prevalence of acute respiratory symptoms (ARS) in breath-hold divers (BHDs) in practicing breath-hold diving. A retrospective investigation has been performed using specific questionnaires completed by a selected sample of free-divers (212 breath-hold diving instructors--194 male, 18 female; mean age 34 +/- 6.91 years); affiliated with Apnea Academy, (International School for Education and Research of Free-Diving). We also investigated possible risk factors for post-dive acute respiratory symptoms. Furthermore, the authors report that a severe case of acute pulmonary edema occurred to a healthy and experienced b...

We aimed to evaluate retrospectively the data of patients undergoing bronchial artery embolizatıon (BAE) for massive or non-massive hemoptysis in our clinic and discussed with the literature. Materials and Methods: We retrospectively evaluated patients with acute severe or chronic recurrent hemoptysis admitted to the pulmonology department and submitted to BAE for the purpose of embolization. Results: A total of 52 patients were submitted to BAE, 41 (78.8%) were male, with a mean age 53.7±14.8 years. Hemoptysis was considered severe in 22 (42.3%) patients. Bronchiectasis (other than cystic fibrosis) (n=12; 23.1%) and tuberculosis (TB) sequelae (n=11; 21.2) were the major etiology for hemoptysis. None of our patients developed early or late complications related to the procedure. Hemoptysis recurred in five patients at 12-month follow-up of each patient. There was no significant difference between the amount of hemoptysis and the presence of lesion on computed tomography, active bleeding on bronchoscopy or recurrence. Conclusion: Bronchiectasis (except those associated with cystic fibrosis), TB, and TB sequelae were the major etiologies for hemoptysis. Our results show that BAE is a safe and effective treatment supporting the current literature for acute massive and chronic recurrent hemoptysis.

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'Does tranexamic acid stop haemoptysis'? Altogether 49 papers were found using the reported search strategy, of which 13 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. This consisted of one systematic review including a meta-analysis of two double-blind randomized controlled trials (RCTs), the two RCTs, one cohort study, two case-series and seven case reports. Main outcomes included bleeding time, bleeding volume and occurrence of thromboembolic complications after start of treatment. Based on results from the meta-analysis, no difference in remission of bleeding within 1 week was found between tranexamic acid (TA) and placebo groups (odds ratio 1.56, 95% CI: 0.44-5.46). However, overall bleeding...

Diffuse alveolar haemorrhage (DAH) is a manifestation of several immune and nonimmune diseases. The objective of this study was to characterize the clinical characteristics and short-term outcomes of patients with immune-mediated DAH requiring hospital admission. A retrospective study from December 2010 to December 2015, was conducted by analyzing the clinical records of 39 patients with DAH with a proven immunological origin. The diagnosis of individual collagen vascular diseases (CVD) was made according to the criteria of the corresponding societies. Thirty-nine patients were included (median age 44.8 years, range 16-76). The main causes of DAH were ANCA-related vasculitis (74.3%) mainly granulomatosis with polyangiitis (n = 14) and microscopic polyangiitis (n = 13). Thirty patients (76.9%) had hemoptysis. An alveolar airspace filling pattern was found in most of patients (59%). All the patients had a drop in hemoglobin level that ranged from 1.0 to 3.0 g/dL. BAL fluid was macrosc...

Le but de ce travail a été d’étudier les conséquences du tabagisme sur les manifestations cliniques, radiologiques et évolutives de la tuberculose pulmonaire.Il s’agissait d’une étude cas-témoin, rétrospective portant sur 90 patients ayant une tuberculose pulmonaire : 45 tabagiques (groupe I) et 45 non tabagiques (groupe II). Pour l’analyse de la gravité des lésions radiologiques, nous avons utilisé un score inspiré de celui du bureau international de travail des pneumoconioses permettant de chiffrer l’importance et l’étendue des lésions radiologiques. Ces lésions ont été classées en 4 grades de sévérité.La moyenne d’âge des patients était de 29 ans (16 à 50), tous étaient de sexe masculin. La symptomatologie clinique était comparable. Une tendance vers les scores de sévérité radiologiques les plus élevés a été observée dans le groupe I par rapport au groupe II (81 % versus 15 %, p < 0.001). À la guérison, les séquelles radiologiques étendues ne s’observaient que pour le groupe des tabagiques (13,8 % versus 0 %).Notre étude constitue l’une des rares qui s’est intéressée à comparer l’importance des lésions radiologiques chez des tuberculeux tabagiques et non tabagiques. Le tabagisme expose plus au risque d’avoir des lésions radiologiques plus étendues (évolutives ou séquellaires) par rapport au non tabagiques. Le sevrage tabagique doit faire partie intégrante de la prise en charge du patient atteint de tuberculose.Tobacco smoking and tuberculosis (TB) are two major public health problems, and the former may affect the morbidity and mortality rates for the latter. This study sought to compare the clinical and radiologic aspects of pulmonary TB, as well as outcome, in smokers and nonsmokers.This retrospective case control study examined the files of 90 patients in our pulmonary department with active pulmonary TB, 45 of them smokers and 45, nonsmokers. To analyze the seriousness of the radiologic lesions, we used a score based on the International Labour Organization classification for simple pneumoconiosis, rating lesions in 4 grades according to severity and extent.The mean age of the patients, all men, was 29 years (range: 16-50 years). Symptoms were similar in both groups, with no significant clinical or bacteriological differences between the two groups. However, the highest severity score was found in 81% of the smoking group compared with 15% of the nonsmokers (p < 0.001). Moreover, after patients were cured, only smokers had severe radiological sequelae (13.8% versus 0%, p < 0.05).Our study is one of the few to compare the radiological appearance of TB in smoking and nonsmoking patients. Smoking is associated with much more extensive and severe radiological TB lesions and sequelae and increases the risk of morbidity and mortality in TB patients. Therefore smoking prevention and cessation should be a priority in TB prevention programs.

Leptospirosis is a re-emerging zoonosis occurring as large outbreaks throughout the world caused by Leptospira interrogans. The incidence of pulmonary involvement in leptospirosis has been reported to be increasing in the last years, affecting up to 70% of the patients. Alveolar hemorrhage presented as dyspnea and hemoptysis is the main pulmonary manifestation. The emergence of massive hemoptysis and acute respiratory distress syndrome has characterized the recent changes reported in the clinical patterns of leptospirosis. The pulmonary involvement has been emerged as a serious life threat, becoming the main cause of death due to leptospirosis in some countries. In this review we present the main clinical and pathological manifestations of pulmonary involvement in leptospirosis, with special focus on recent data concerning the pathophysiological mechanisms underlying lung injury.

We present a case of 39-year-old male with the symptoms of fever, cough, chest pain and bloody phlegm, whose chest CT showed multiple subpleural nodules and inflammatory infiltration. Video-Assisted Thoracic Surgery ( VATS ) for right subplural nodule was performed and confirmed the diagnosis of necrotizing sarcoid granulomatosis. Prednisolone was administered and the symptoms were under control untill the occurrence of intermittent hemoptysis after 10 months. Chest CT and bronchoscope revealed the right lower lobe nodule with intraluminal necrotic tissue in the right lower lobe posterior basal segment respectively. Fatal hemoptysis happened during endobronchial biopsy by flexible bronchoscope forcep. Based on this case, we reviewed the relevant literature and discussed the clinical features, pathological changes and prognosis of the disease. The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1955868163936338.

Objective: Alveolar hemorrhage (AH) is a rare complication of treatment with GP IIb/IIIa inhibitors. Hemoptysis, a constant sign, lacks in specificity, and may occur in confounding syndromes such as pulmonary edema, pulmonary infarction, and pneumonia. Nonspecific symptoms and signs often delay the diagnosis, thereby allowing serious or even fatal disease progression. Here, we performed a large-scale retrospective analysis to define the incidence and risk factors of AH in the setting of GP IIb/IIIa inhibitors therapy.Background: Randomized controlled trials demonstrate that treatment with glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors may improve the outcome of acute myocardial infarction (AMI) and angioplastic procedures. However, this treatment may rarely lead to severe hemorrhagic complications, in particular AH. Unfortunately, the incidence and risk factors of AH remain poorly defined.Methods: We reviewed for the period extending from August 1998 to January 2005 consecutive histories of AMI patients receiving coronary arteriography and treatment with either eptifibatide or abciximab. Concomitantly admitted AMI patients not treated with GP IIb/IIIa inhibitors were reviewed and served as a control group. The diagnosis of AH required the demonstration of typical symptoms and signs including dyspnea, hemoptysis, arterial hypoxemia, pulmonary radiographic changes, and, when available, bronchoscopic signs for AH. Potential covariates including pulmonary disease, pulmonary hypertension, smoking, and use of other anticoagulant or antiplatelet agents were evaluated.Results: Six of 1,810 patients (0.33%) receiving eptifibatide and five of 3,648 patients (0.14%) receiving abciximab exhibited typical symptoms and signs of AH. Contrarily, only one of 4,136 patients (0.025%) receiving no GP IIb/IIIa inhibitors presented with similar symptoms and signs. There was no fatal outcome, though two patients required blood transfusions. Statistically significant differences were found between control patients and patients receiving eptifibatide alone (P = 0.004). There was also a significant difference between untreated patients and those receiving eptifibatide and abciximab (P = 0.017). No differences were found between eptifibatide and abciximab-treated patients (P = 0.19) or between abciximab and untreated control patients (P = 0.105).Conclusions: AH is a rare complication of treatment with GP IIb/IIIa inhibitors. Its incidence ranged from 0.14% in patients treated with abciximab to 0.33% in those receiving eptifibatide. Compared to a control group, patients treated with GP IIb/IIIa inhibitors had a statistically increased risk for AH.

During the past decade percutaneous therapeutic vascular occlusion was performed on 152 occasions in 124 patients. The primary indication for vasoocclusive therapy was acute or recurrent bleeding. Upper gastrointestinal bleeding from arterial sources was controlled in 92 percent of patients and acute variceal bleeding in 83 percent. Renal embolization was performed for palliation of severe pain and hematuria from unresectable renal primary or secondary malignancies, to decrease blood loss and facilitate surgery in operable renal tumors, and for ablation of renal function to control chronic protein loss or severe hypertension. Our encouraging experience convinces us that transcatheter embolization is a useful, safe and effective procedure in selected patients. It seems certain that the technique of therapeutic embolization will be improved, its indications extended and its application become commonplace whenever angiographic skills and facilities exist.