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Massive hemoptysis from an endobronchial metastasis of thyroid papillary carcinoma.

A 68-year-old female was admitted to our hospital with massive hemoptysis. She had undergone total thyroidectomy and postoperative radioisotope therapy for thyroid papillary carcinoma associated with multiple lung metastases one year before the present disorder. The right middle lobe was resected because of lethal airway bleeding from the lobe. Pathological examination showed an endobronchial metastasis 30 mm in size at the segmental bronchi. Other numerous small metastatic lesions exhibited two growth patterns: subepithelial endobronchial metastasis at the peripheral bronchi and visceral pleural metastasis. Endobronchial metastasis is an extreme type of lung metastasis of thyroid carcinoma, and can cause massive hemoptysis as the lesion increases in size.

Aged↗

Blood clots mimicking peripheral intrabronchial tumors in patients with hemoptysis: CT and bronchoscopic findings.

We report radiographic and clinical findings in two cigarette-smoking patients presenting with hemoptysis. On CT, both patients had peripheral intrabronchial masses together with parenchymal opacities. Bronchoscopy revealed the intrabronchial masses to be blood clots and the parenchymal opacities to correspond to areas of parenchymal hemorrhage. Our cases are novel in that both bronchial and parenchymal sequelae of hemorrhage were simultaneously visualized by CT. Also, our findings suggest that bronchial blood clots should be included in the differential diagnosis of peripheral intrabronchial lesions, notably in patients presenting with hemoptysis.

Adult↗

Hemoptysis in trauma.

In an attempt to more clearly delineate the importance and pathophysiology of moderate-severe hemoptysis, a clinical and experimental study was performed. The clinical portion consisted of a retrospective review of 344 patients undergoing thoracotomy for penetrating trauma. There were 138 patients with injuries to the trachea, mainstem bronchi or lungs. Six with GSW to the chest had severe hemoptysis in the Emergency Department (ED) and had a cardiac arrest just after endotracheal intubation. At thoracotomy, all six had air in their coronary arteries and could not be resuscitated, Of 14 patients with posterolateral OR thoracotomies, three had significant (20-30 mm Hg) drops in systolic pressure plus increased aspiration of blood into the dependent lung when turned onto their sides. Of 12 patients surviving surgery, six with continued aspiration of blood required prolonged ventilatory support. In an experimental study, minimally heparinized (0.07 units/ml) blood was infused into the lower trachea of 17 anesthetized normovolemic supine dogs at 0.15 ml/kg/min. The PaO2 fell from 100 +/- 11 to 65 +/- 16 mm Hg after infusion of 4.5 ml/kg of blood. At the same time peak ventilator pressure rose only minimally (8.5 +/- 1.7 to 11.2 +/- 3.1 mm Hg). The PCO2, mean PA pressure, PAWP, CVP, and cardiac output were essentially unchanged. In a second study of 18 dogs, reducing the systolic BP by one third reduced cardiac output by almost 48% and oxygen transport by 58%. After 4.5 ml/kg blood were infused into the trachea, the PaO2 fell from 84 +/- 19 to 52 +/- 9 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Isolated bronchial capillary hemangioma: a rare benign cause of hemoptysis.

A 74-year-old male cigarette smoker presented with hemoptysis and a right upper lobe infiltrate. Fiberoptic bronchoscopy revealed a small (1 x 2 mm) benign-appearing lesion in the right upper lobe bronchus which, on biopsy, was a submucosal capillary hemangioma. This is an exceedingly rare tumor and, to our knowledge, hemoptysis from these lesions in the proximal bronchi has not been previously reported.

Aged↗

Chronic hemoptysis: an unusual manifestation of fungal sinusitis.

A woman with chronic hemoptysis as her only complaint had extensive testing and did not respond to antibiotic therapy. Radiologic examination of the sinuses identified a mass which, on surgical exploration, was found to be the result of a fungus, Pseudallescheria boydii. Although this fungus is known to be a cause of epistaxis, this is the first instance in which it has been reported to cause hemoptysis.

Adult↗

Hemoptysis as the sole presentation of Pasteurella multocida infection.

Pasteurella multocida has been implicated as the cause of a variety of respiratory conditions (eg, bronchitis, pneumonia, lung abscess, empyema), but hemoptysis has been noted only in conjunction with other lung conditions. We report a case in which hemoptysis was the sole manifestation of Pasteurella infection. The patient was a middle-aged man with severe obstructive lung disease and exposure to cats. Diagnosis was made by bronchoscopy and high-dose penicillin was required for resolution.

Animals↗

Pneumococcal abscess manifesting as an anterior mediastinal mass and fatal hemoptysis.

An elderly man had several weeks of night sweats, weight loss, and an anterior mediastinal mass on chest radiography. Computed tomographic-guided needle aspiration was nondiagnostic. Shortly after the patient's admission, three sets of blood cultures yielded Streptococcus pneumoniae. Despite systemic antimicrobials, the patient had an episode of acute hemoptysis and died. Autopsy showed an anterior mediastinal abscess with pneumonic involvement of the left lung. There was histologic evidence of necrotizing pneumonia and parenchymal hemorrhage, which likely resulted in fatal hemoptysis.

Abscess↗

An Aspergillus luchuensis isolated from a patient with hemoptysis insights from a comprehensive genome-based analysis: Case report.

RATIONALE: Asp luchuensis, a member of the A niger group, is widely used in food fermentation and rarely causes invasive pulmonary aspergillosis (IPA) in humans. Clinical cases of IPA induced by this strain are extremely scarce, and its genomic characteristics, virulence profiles, and pathogenic mechanisms remain poorly understood, resulting in insufficient clinical recognition of its invasive infection potential. PATIENT CONCERNS: A 57-year-old immunocompetent non-neutropenic male patient with a long-term smoking and drinking history presented with unexplained severe cough and massive hemoptysis (approximately100 mL) without other typical infectious symptoms. DIAGNOSES: Combined with chest computed tomography (CT) inflammatory lesions, positive galactomannan test, fungal PCR and metagenomic next-generation sequencing results, the patient was definitively diagnosed with probable A luchuensis-induced IPA. Genomic and transcriptomic analyses confirmed the pathogen as a variant A luchuensis strain with 3 key hypervirulence genes, highly active mitochondrial energy metabolism, and no specific antifungal resistance genes. INTERVENTIONS: The patient received standardized intravenous antifungal combination therapy with voriconazole and amphotericin B after confirmed diagnosis. OUTCOMES: The patient's cough and hemoptysis were significantly relieved after 10 days of treatment, with stable vital signs and no adverse drug reactions or disease progression. LESSONS: A luchuensis possesses strong invasive pathogenicity and can trigger IPA even in non-neutropenic immunocompetent individuals. Negative conventional microbial tests cannot exclude its infection, and mNGS is a reliable diagnostic tool. This strain is susceptible to routine antifungal drugs, and clinicians should raise awareness of atypical Asp species-induced invasive pulmonary infections.

Humans↗

Pulmonary mucormycosis with fatal massive hemoptysis.

A case of pulmonary mucormycosis in a 57-year-old woman with acute promyelocytic leukemia (APL) who died of massive hemoptysis is reported. Chest radiography revealed changes that began with a small focal infiltration and progressed to a large round nodule with cavity formation. Postmortem examination showed the nodule to be composed mainly of infarcted lung tissue with saprophytic growth of Mucor. An adjacent proximal branch of the left pulmonary artery was thrombosed with mucoraceous hyphae, and it had ruptured into the cavitary space around the necrotic tissue and then into a conducting bronchus. In general, both fatal massive hemoptysis and cavity formation are rare in pulmonary mucormycosis. In our present case, the histological findings suggested that both phenomena were closely related to the pulmonary infarction caused by Mucor invasion of the pulmonary artery.

Female↗

Syphilitic aneurysm of the right subclavian artery presenting with hemoptysis.

A 40-year-old Australian Aboriginal female presented with hemoptysis in association with a right upper zone pulmonary and mediastinal mass. Several syphilitic infections in the patient had been documented during the previous 16 years. Death was due to a large hemoptysis, and autopsy revealed that the mass in the chest was a right subclavian artery aneurysm which had ruptured into the lung parenchyma.

Adult↗

Bronchial artery embolization for hemoptysis in young patients with cystic fibrosis.

PURPOSE: To review the authors' 15-year experience with bronchial artery embolization (BAE) for treatment of hemoptysis in young patients with cystic fibrosis. MATERIALS AND METHODS: By searching the 1985-1999 radiology database, the authors identified 23 young patients who had been referred to the radiology department for angiography. Twenty of these patients underwent BAE. The 23 medical records were retrospectively reviewed with regard to embolization agents used, embolization success rates, number of repeat embolizations, survival times, and causes of death. RESULTS: BAE was performed on 38 occasions in 20 patients. The mean age of patients at first BAE was 15 years (age range, 7-19 years). The majority (n = 34 [89%]) of BAEs were performed by using polyvinyl alcohol. The immediate success rate after BAE (ie, no recurrent bleeding within 24 hours) was 95% (36 of 38 BAEs). Eleven (55%) patients required more than one BAE, and the median time between first and second embolizations was 4 months (range, 5 days to 61 months). Three patients died as a consequence of severe hemoptysis during induction of anesthesia with intermittent positive pressure ventilation in preparation for BAE. The median survival duration after the first BAE (Kaplan-Meier estimate) was 84 months (average follow-up, 61 months; range, 5 days to 169 months). CONCLUSION: BAE had a high success rate for short-term control of bleeding; however, more than half the patients required repeat embolization during the long-term follow-up.

Adolescent↗

Control of massive hemoptysis by embolization of intercostal arteries.

The embolization of intercostal arteries for the control of massive hemoptysis is described in two patients with bronchopleural fistulas and in one patient with sarcoidosis. Hemoptysis was controlled by embolization in all three cases, but spinal cord infarction occurred in one patient as a result of the procedure. This complication can occur even in cases where no significant blood supply to the spinal cord can be seen on preliminary arteriography, which suggests that in some patients angiographically invisible small branches play an important role in the blood supply to the spinal cord. These branches may be particularly important in cases in which the spinal blood supply is already compromised by surgery, radiation therapy, or previous embolization procedures.

Adult↗

Patients with hemoptysis examined by Tc-99m sulfur colloid and Tc-99m-labeled red blood cells: a preliminary appraisal.

A prospective study of 16 patients with hemoptysis was conducted over a 2 1/2-year period. Technetium-99m sulfur colloid (Tc-SC) and technetium-99m-labeled red blood cells (Tc-RBC) were sequentially used to identify the general area of bleeding. Tc-SC accurately located the bleeding area in 3 patients and Tc-RBC identified the bleeding area in 8; there were no false-positive studies. Tc-SC scans were positive at 6-10 minutes and all patients had positive Tc-RBC studies. In general, the scans accurately located the source of bleeding as determined by bronchoscopy and/or surgery. Because of the small sample, statistically significant differences between both techniques were not ascertained. Both Tc-SC and Tc-RBC may prove to be helpful, minimally invasive imaging procedures for determining the general area of hemorrhage in patients with clinically significant hemoptysis. Although a trend suggests that Tc-RBC is a more sensitive method, further comparison is needed for corroboration.

Adult↗

Nonbronchial systemic collateral arteries: significance in percutaneous embolotherapy for hemoptysis.

Twenty patients with massive or recurrent hemoptysis underwent percutaneous transcatheter embolotherapy between 1979 and 1986 for the following diseases: cavitary aspergillosis (n = 4); cystic fibrosis (n = 4); tuberculosis (n = 3); bronchogenic carcinoma (n = 3); bronchiectasis (n = 3); small cell lung carcinoma 6 years after irradiation (n = 1); congenital heart disease, after Glenn and Blalock anastomoses (n = 1); and unknown interstitial disease (n = 1). Bronchial arteries were embolized in all but one patient. In nine patients (45%) nonbronchial systemic collateral arteries contributed significantly to areas of pathologic pulmonary tissue and frequently were the major arterial supply. These nonbronchial systemic collaterals included branches of the subclavian and axillary arteries (n = 7), intercostal arteries (n = 5), and phrenic arteries (n = 3) and accounted for 59.5% of the total number of arteries embolized. Recognition and occlusion of nonbronchial systemic collaterals providing blood to hypervascular pulmonary lesions is essential for successful percutaneous embolotherapy of hemoptysis.

Adolescent↗

Control of hemoptysis: systemic angiography and anastomoses of the internal mammary artery.

Twenty-three patients with massive and recurrent hemoptysis were examined with angiography. Particular attention was directed to the internal mammary arteries. Specific causes for the bleeding were tuberculosis (n = 9), aspergilloma (n = 8), bronchiectasis (n = 1), primary systemic amyloidosis (n = 1), congenital and acquired pulmonary venous obstruction (n = 2), chronic pulmonary embolism (n = 1), and bilateral congenital pulmonary artery stenosis (n = 1). Eleven of these 23 patients were treated with systemic arterial embolization, and immediate cessation of bleeding occurred in nine. The recognition of the numerous collateral vessels and anastomoses of the internal mammary arteries is essential for successful percutaneous embolization for hemoptysis. The authors outline these various pathways and collateral vessels.

Adult↗