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Bronchial artery embolization to control hemoptysis in cystic fibrosis.

Severe hemoptysis in cystic fibrosis can be life-threatening because of acute blood loss or because it interferes with sustaining physical therapy of the chest. Hemoptysis was controlled in 19 of 20 cystic fibrosis patients by means of embolization with a combination of 250-590-microns particles of polyvinyl alcohol foam and absorbable gelatin pledgets. Repeat embolization was needed in eight patients to achieve or maintain effective hemostasis. One or more aberrant bronchial arteries were found in seven patients (35%), and a spinal artery branching from a vessel that also supplied bronchial circulation was present in 11 patients (55%). The data suggest that although embolization has a wider applicability than previously reported, care should be taken during angiography to evaluate the bronchial circulation because aberrant bronchial vessels and spinal arteries arising from bronchial circulation are common.

Adolescent↗

Hemoptysis: CT-bronchoscopic correlations in 58 cases.

Computed tomographic (CT) and chest radiographic findings were retrospectively correlated with those found at fiberoptic bronchoscopy (FOB) in 58 patients presenting with hemoptysis. Abnormalities involving the airways were depicted by CT in a total of 28 cases (48%). In 18 of these (31% of the total group of 58), focal abnormalities involving the central airways were identified (17 were subsequently proved to be malignant) and in 10 (17% of the total), CT showed bronchiectasis. Focal airway abnormality was shown by FOB in 18 cases (31%); all of these were depicted with CT. Malignancy was diagnosed in 24 patients, including three in whom results of FOB were normal but malignant cells were identified at transbronchial biopsy. CT abnormalities were identified in all cases of malignancy. In 10 of 21 cases (48%) of non-small cell lung cancer, CT allowed definitive staging by documenting either direct mediastinal invasion and/or metastatic disease, while FOB allowed definitive staging in only three cases. CT studies provided no false-negative results. It is concluded that when carefully performed, CT may be an effective modality for evaluating patients presenting with hemoptysis.

Adult↗

Hemoptysis: comparative study of the role of CT and fiberoptic bronchoscopy.

PURPOSE: A prospective study was performed to compare results of computed tomography (CT) and fiberoptic bronchoscopy in diagnosis of cancer in patients with hemoptysis. MATERIALS AND METHODS: Ninety-one patients (64 men, 27 women) with hemoptysis underwent thin-section CT and fiberoptic bronchoscopy. RESULTS: CT scans demonstrated all 27 tumors seen at bronchoscopy and an additional seven, five of which were beyond bronchoscopic range. In patients with normal chest radiographs, bronchial carcinoma was detected in 5% at both bronchoscopy and CT. In patients with abnormal findings on radiographs, bronchoscopy allowed both location and histologic diagnosis in 78% of carcinomas but was unreliable in locating peripheral tumors demonstrated at CT. CT was insensitive in demonstrating early mucosal abnormalities, bronchitis, squamous metaplasia, and a benign papilloma, all detected at bronchoscopy. CONCLUSION: The initial examination should be bronchoscopy when there is high clinical suspicion of carcinoma and relevant radiographic abnormality, and CT when strong clinical suspicion of carcinoma is not substantiated at bronchoscopy in patients with normal findings on chest radiographs.

Bronchiectasis↗

Munchausen's syndrome presenting as hemoptysis in a 12-year-old girl.

The case of Munchausen's syndrome presenting as hemoptysis in a 12-year-old girl is presented. The features of Munchausen's syndrome are reviewed. Munchausen's syndrome should be included in the differential diagnosis of hemoptysis in a child, especially when accompanied by a dramatic presentation, changing symptoms and negative diagnostic investigations.

Child↗

Glomerular basement membrane thinning in a patient with hematuria and hemoptysis mimicking Goodpasture's syndrome.

Ultrastructural morphometric studies of glomerular basement membrane (GBM) thickness are described in two renal biopsy specimens from a patient who presented with hemoptysis and hematuria mimicking Goodpasture's syndrome. Significant GBM abnormality, with attenuation as the main lesion, identified in a biopsy specimen taken during active clinical disease appeared to have resolved in a second biopsy specimen taken during the recovery phase. There was no evidence of glomerulonephritis. Concurrent lung biopsy studies showed focal alveolar-capillary wall basal lamina changes of uncertain diagnostic significance. These observations suggest the alternative possibilities that GBM attenuation may be either an acquired consequence of systemic disease or may be part of an hitherto unrecognized primary multisystem abnormality of basal lamina affecting, in this case, glomerular and pulmonary laminae, resulting in hematuria and hemoptysis. The morphometric studies in this case indicate that simple-mean measurements of GBM thickness are inadequate alone for the quantitative study of this lamina because significant inter- and intraglomerular membrane variation, if irregularly distributed, can remain undetected.

Aged↗

Repeat fiberoptic bronchoscopy in patients with recurrent, unexplained hemoptysis.

Repeat fiberoptic bronchoscopy (FB) is indicated in patients with recurrent, unexplained hemoptysis to localize and/or diagnose the source of bleeding. The results of 34 bronchoscopies in 14 patients over a 6-year period were examined. 10 patients had 2 FBs each and 1 patient had 5 procedures at varying intervals. Only early FB detected active bleeding (12/25) early FBs) and localized a bleeding site (10/25). Definitive diagnoses (6/34 FBs) occurred only in patients with lung malignancy and were not necessarily influenced by the timing or frequency of FB. Clinical diagnoses and management were infrequently altered by each FB, except for management of malignancy. Thus, early, repeat FB in this diagnostically difficult group of patients contributes limited immediate information and minimally changes therapy in patients with nonneoplastic conditions. Despite these limitations, direct bronchial visualization by FB remains the most reliable standard available for localizing and, to a lesser extent, diagnosing the etiology of recurrent hemoptysis.

Adult↗

Treatment of massive hemoptysis by combined occlusion of pulmonary and bronchial arteries.

Massive, life-threatening hemoptysis occurred in a patient with left upper lobe bronchiectasis secondary to old tuberculosis. Selective left bronchial arteriography showed extravasation of contrast medium in the bronchiectatic area. A marked decrease in hemoptysis occurred after selective left bronchial arterial embolization. Complete cessation of bleeding followed the inflation of a Swan-Ganz balloon catheter that had been placed in the left main pulmonary artery.

Aged↗

Diffuse alveolar septal amyloidosis presenting with recurrent hemoptysis and medial dissection of pulmonary arteries.

An unusual case of recurrent hemoptysis in a 56-yr-old woman is presented. After all the usual investigations for hemoptysis, left lower lobectomy revealed medial dissection of small and medium-sized pulmonary arteries with evidence of amyloid deposition. The patient subsequently developed the clinical picture of diffuse alveolar septal amyloidosis in association with primary amyloidosis. Pulmonary artery dissection is briefly reviewed, and vascular amyloidosis is presented as the probable origin in this case.

Amyloidosis↗

Agenesis of the left pulmonary artery as a cause of hemoptysis.

Agenesis of a pulmonary artery is an unusual cause of hemoptysis. Presented here is a case of agenesis of the left pulmonary artery which presented following a subendocardial infarction which raised the suspicion for pulmonary embolus. Despite a ventilation perfusion long scan which showed absent perfusion to the left lung, the clinical absence of tachypnea and dyspnea led to pulmonary angiography and thence to the correct diagnosis. Anticoagulant and/or thrombolytic therapy were withheld and the patient was treated conservatively. Agenesis of a pulmonary artery is a rare cause of hemoptysis, but may mimic pulmonary emboli and should be considered in the differential diagnosis. Failure to recognize this clinical entity could lead to unwanted and potentially harmful anticoagulant or thrombolytic therapy.

Diagnosis, Differential↗

Bronchial arteriovenous malformation in a child with hemoptysis. A case report.

Pulmonary arteriovenous (AV) malformations occur sporadically and in the pediatric population are most commonly associated with hereditary hemorrhagic telangiectasia. Hemoptysis is an infrequent presentation in this age group. Pulmonary angiography is considered to be the definitive diagnostic modality. The authors describe an otherwise healthy eleven-year- old girl who presented with massive hemoptysis secondary to a large bronchial AV malformation unrelated to any congenital anomalies. The pulmonary angiogram appeared normal and the diagnosis was established by digital subtraction aortography. Successful embolotherapy was performed by selective injection of polyvinyl alcohol particles into the culprit bronchial artery.

Arteriovenous Malformations↗

Follicular carcinoma of Hürthle cell type as cause of hemoptysis.

Summary--A patient with follicular carcinoma, Hürthle cell type, who developed subglottic extension and uncontrollable hemoptysis is presented . In consideration of the patient's age a conservative therapeutic program was instituted with a definite response to I-131 therapy despite poor radioactive iodine (RAI) uptake by the tumor. Laryngectomy and thyroidectomy were eventually required to control hemoptysis; the patient remains socially functional and asymptomatic after a 30-month period. The two-year period of weekly office visits and temporizing treatment as occurred in this patient cannot be recommended. It seems appropriate to advocate surgical treatment including laryngectomy for follicular carcinoma, Hürthle cell type, localized to the laryngotracheal area without regard for the age of the patient.

Adenocarcinoma↗

Hemoptysis as a presentation of mild hemophilia A in an adult.

It is not unusual for mild hemophilia A to escape detection into adolescent years and it is often detected following dental extractions or other mild trauma. The present report describes a patient shown to have only 8 to 9 percent factor VIII activity at age 30 years. The presentation of recurrent mild hemoptysis with upper respiratory tract infections is unusual and of interest in the differential diagnosis of hemoptysis.

Adult↗

Hemoptysis during sexual arousal. An unusual manifestation of amyloidosis.

Hemoptysis associated with sexual arousal is thought to be secondary to cardiac dysfunction brought on by the physiologic stress of sexual activity. A patient who presented with hemoptysis occurring only during episodes of sexual stimulation was subsequently found to have cardiac amyloidosis.

Amyloidosis↗

Amiodarone-associated hemoptysis.

The manifestations of amiodarone pulmonary toxicity (APT) are generally nonspecific, and a diagnosis requires appropriate clinical history, laboratory testing consistent with toxicity, and exclusion of other disease entities. To our knowledge, hemoptysis associated with APT has not been described before; the following report describes such a case. We suggest that APT should be considered among the differential diagnosis of hemoptysis in a patient receiving amiodarone.

Aged↗

Catamenial hemoptysis. Diagnosis with MRI.

Thoracic endometriosis is a rare disorder. We report a case of a 26-year-old woman with a 4-year history of catamenial hemoptysis due to thoracic endometriosis which was diagnosed by MRI and treated successfully by means of video-assisted thoracoscopic wedge-resection of the solitary pulmonary lesion. Medical therapy with hormones was not necessary. There is no evidence of recurrence 10 months after the operation. This case demonstrates that MRI of the chest may be considered for the diagnostic work-up of patients with catamenial hemoptysis. It also shows that wedge-resection of pulmonary endometriosis foci by means of video-assisted thoracoscopy-an approach that has not been described in the literature thus far-is an effective therapy in localized peripheral pulmonary parenchymal endometriosis.

Adult↗

Hemoptysis as the presenting symptom in bronchiolitis obliterans organizing pneumonia.

Bronchiolitis obliterans organizing pneumonia (BOOP) is an uncommon but increasingly recognized pulmonary entity that usually presents with symptoms of dyspnea, cough, and fever. The medical literature describes rare cases of hemoptysis in BOOP, with very small quantities of blood expectorated. We describe two cases of BOOP, one idiopathic and one in association with rheumatoid arthritis, in which large-quantity hemoptysis was the primary presenting symptom.

Aged↗