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Recurrent hemoptysis due to aortobronchopulmonary fistula of false aortic aneurysm associated with repair of rupture of the sinus of Valsalva.

A 54-year-old man presented with recurrent hemoptysis of one year duration. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a saccular aneurysm of the ascending aorta. The aneurysm was intraoperatively found to have formed on the superior surface of the site of aortotomy suture placed during previous repair of rupture of the sinus of Valsalva and to have a fistulous communication to the lung. CT and MRI were very useful in the diagnosis of the aneurysm as the cause of hemoptysis.

Aortic Aneurysm↗

Acute respiratory failure with gross hemoptysis in a patient with lymphangioleiomyomatosis as part of tuberous sclerosis complex.

A 29-year-old woman was admitted to our hospital with a 7-day history of elevated temperature to 39.5 degrees C associated with headache and nausea. She had been diagnosed with tuberous sclerosis complex 10 years earlier. Her unconsciousness progressed, and she was diagnosed as having aseptic meningoencephalitis. The next day, she had a generalized seizure with severe hemoptysis, and she suddenly fell into severe respiratory failure (PaO2/FiO2 = 76.9). Transbronchial lung biopsy revealed the findings of lymphangioleiomyomatosis. It was suggested that neurogenic pulmonary edema accompanied with venous flow obstruction by lymphangioleiomyomatosis lesions resulted in diffuse pulmonary hemorrhage with resultant gross hemoptysis accelerating to severe hypoxemia.

Adult↗

Bronchography in patients with hemoptysis.

Retrospective analysis of 196 cases suggests that bronchography has limited value in the evaluation of hemoptysis. Most patients with a single episode of hemoptysis and normal plain chest roentgenographic and bronchoscopic findings do not require bronchographic examination. Advances in cytologic and biopsy procedures (fiberoptic bronchoscopy, bronchial brushing, needle aspiration) have largely replaced the usefulness of bronchography even when the plain chest roentgenogram is abnormal.

Bronchial Diseases↗

Hemoptysis. Three questions that can direct management.

Hemoptysis can be a life threatening condition on its own. It can also be a marker of serious disease or a recurrent problem accompanying lung cancer, bronchiectasis, or tuberculosis. A three-step approach is of fundamental importance: First, ensure that the lower respiratory tract is the source of bleeding. Second, identify cases representing serious risk. Third, consider both pulmonary and systemic circulation as possible sources of bleeding. In most cases, a non-specific, conservative approach is successful in managing hemoptysis, but occasionally, surgical resection or embolization of the bleeding vessel is required.

Hemoptysis↗

Clinical signs, clinicopathological findings, etiology, and outcome associated with hemoptysis in dogs: 36 cases (1990-1999).

Hemoptysis, the expectoration of blood or bloody mucus from the respiratory tract at or below the larynx, was retrospectively evaluated in 36 dogs. Cough, tachypnea, and dyspnea were common historical and physical examination signs. Anemia was documented in 11 dogs, but was severe in only one dog. Other clinicopathological findings reflected the underlying diseases. All thoracic radiographs obtained were abnormal; alveolar and interstitial patterns were most common. Diseases predisposing to hemoptysis included bacterial bronchopneumonia (n=7), neoplasia (n=5), trauma (n=5), immune-mediated thrombocytopenia (n=4), heartworm disease (n=4), rodenticide poisoning (n=3), lung-lobe torsion (n=1), left-sided congestive heart failure (n=1), pulmonary hypertension (n=1), and foreign-body pneumonia (n=1). Four additional dogs had more than one underlying disease process. Nine dogs were either euthanized or died in the hospital during the initial visit. While at least half of the 27 dogs discharged went on to completely recover, five dogs discharged were known to have either died or been euthanized as a result of their disease in <6 months.

Animals↗

Hemoptysis in a 28-year-old active duty soldier.

A 28-year-old African American male, originally from West Africa, presented with complaints of cough and hemoptysis. This case follows the patient through transfer to Walter Reed Army Medical Center and outpatient follow-up. Exploring this case illustrates how an Army physician may approach a soldier with hemoptysis. Additionally, this case demonstrates the management and treatment of his condition.

Adult↗

Massive hemoptysis as a rare presentation of metastatic choriocarcinoma.

Choriocarcinoma is an uncommon but rapidly invasive and widely metastasizing tumour. Lung is the commonest organ of spread, usually presenting as mild hemoptysis and chest pain in a patient with a recent miscarriage or known molar pregnancy. One such case of a 25 years old woman is reported who did not have any history of recent pregnancy or miscarriage and presented with a life-threatening massive hemoptysis. She responded well to therapy once the diagnosis of metastatic choriocarcinoma was established .

Adult↗

Bronchial artery embolization for massive hemoptysis.

Improved angiographic techniques have proved that therapeutic embolization is effective in controlling massive hemorrhage in selected sites of the gastrointestinal tract and central nervous system. We have controlled massive hemoptysis in five cases with use of our improved techniques and bronchial artery embolization. Because mortality due to massive hemoptysis in both benign and malignant disease is high, therapeutic bronchial artery embolization is the preferable approach in some cases.

Adult↗

Unilateral pulmonary artery agenesis with presentation of hemoptysis: a case report.

Unilateral pulmonary artery agenesis (UPAA), a rare congenital anomaly frequently associated with other cardiovascular abnormalities, is usually diagnosed and surgically treated in childhood. Those who do not suffer other cardiac anomalies (isolated UPAA) have only minor or no symptoms and survive into adulthood. Isolated UPAA in adult patients may present as recurrent respiratory tract infection, dyspnea on exertion, hemoptysis or an incidental finding of an abnormal chest radiograph. We present the case of a 38-year-old man with a congenital absence of the right pulmonary artery (PA) and recurrent hemoptysis. The diagnosis was confirmed by cardiac catheterization, which disclosed an absence of the right PA and systemic collaterals to the right lung from the right internal thoracic artery and posterior intercostal arteries.

Adult↗

[Hemoptysis in a patient with a previous surgical correction of a tetralogy of Fallot].

Aorto-bronchial fistula is a rare but associated with a height rare of mortality. Although most reported cases are secondary to infectious aneurysms, cases arising after surgery to correct congenital cardiovascular abnormalities have recently been described. We report the case of a 41-year-old patient with recurrent hemoptysis and a history of Fallot's tetralogy corrected in childhood. Given such a case of hemoptysis in a patient with a history of cardiovascular surgery, the correct diagnostic approach includes fiberoptic bronchoscopy, helicoidal CAT and/or NMR, and aortography. Diagnostic confirmation should be followed soon by corrective surgery.

Adult↗

[Massive hemoptysis during sarcoidosis].

Hemoptysis is a rare but often severe event in sarcoidosis. It usually occurs in patients with advanced, fibrotic lung disease. We herein report the case of a 36-year old female patient with type II pulmonary sarcoidosis who presented with abundant hemoptysis very early during the course of her disease. Two attempts to embolize bronchial arteries remained unsuccessful and surgery was eventually required to stop the bleeding. Clinical, microbiological, radiological and pathological data indicate that haemoptysis was caused by systemic hypervascularization around sarcoidosis granuloma.

Adult↗

[The long-term effect of double embolization of bronchial artery on patients with hemoptysis].

OBJECTIVE: To investigate the long-term effect of bronchial arterial embolization with different material and procedure on patients with hemoptysis. METHOD: Seventy two cases were divided into two groups, one received the double embolization of bronchial artery, the other group used single gelfoam embolization. In double embolization group, the mixture containing gelfoam microspheres (0.5 mm x 0.5 mm), erythromycin and high osmalality sodium chloride were firstly used to embolize the terminal vessels, the gelfoam particle (1 mm x 1 mm) was then used to embolize the main trunk of bronchial artery. RESULT: After 2-4.8 years following up, it turned out that the cure rate and general effectiveness were: the double embolization group 83%, 100% respectively, the single gelfoam embolization group 61%, 95%. By comparison, there were significant difference on cure rate between these two groups(P < 0.05). CONCLUSION: The bronchial arterial double embolization will increase the long-term effect obviously on patients with hemoptysis.

Adolescent↗

Emergent pneumonectomy for hemoptysis in a patient with previous thoracoplasty.

Hemoptysis is a life-threatening episode of respiratory disease. By means of every possible treatment, hemostasis should be obtained to secure the airway as well as to prevent blood loss. We describe an emergency pneumonectomy for massive hemoptysis from destroyed lung in a patient with previous thoracoplasty. After the prolonged ventilation support postoperatively, the patient with compromised lung function recovered well.

Aged↗

[Massive hemoptysis from an aortobronchial fistula].

This is a report of a 61 year old man who was admitted at the Intensive Care Unit because of massive hemoptysis and respiratory failure. Four years before he had had an aortic dissection type A, and at that time an aortic valve, ascending aorta and aortic arch replacement, had been carried out. A thorax CT scan showed an aneurysm of the ascending aorta. A bronchoscopy was normal. In the angiography, a collateral of the left mammary artery was identified as the cause of bleeding and was subsequently embolized. After the procedure, the patient had a new episode of massive hemoptysis, and surgery was recommended. During surgery, the diagnosis of aortobronchial fistula was confirmed but the patient died during the intervention.

Aorta, Thoracic↗

Aortobronchial fistula: a rare etiology for hemoptysis.

Aortobronchial fistula is an extremely rare cause of hemoptysis. Aortobronchial fistula occurs in patients who have a history of thoracic vascular surgery. Because its symptoms are nonspecific, a high index of suspicion is critical if the physician is to detect it. The results of imaging studies (e.g., plain films, computed tomography, and angiography) and bronchoscopy are sometimes, but not always, diagnostic--another reason the diagnosis is difficult. Left untreated, mortality in patients with aortobronchial fistula is 100%. Patients can be salvaged by a variety of techniques, including the placement of an endovascular stent. We describe the case of a 52-year-old man who came to us with hoarseness and hemoptysis, which proved to be underlying symptoms of aortobronchial fistula. He was treated successfully.

Aortic Diseases↗

Anesthetic management of a parturient undergoing cesarean section with a tracheal tumor and hemoptysis.

Anesthetic management of a parturient with respiratory failure associated with hemoptysis, dyspnea, and orthopnea is difficult. An anesthesiologist should realize that the patient's major problem is not solved during the surgery. This circumstance is similar to a patient with associated cardiac disease scheduled for non-cardiac surgery. General anesthesia with endotracheal intubation can provide safe oxygenation for both the parturient and the fetus, but with possible unexpected massive hemoptysis and tumor seeding. Prolonged intubation may delay the patient's pulmonary treatment course. Laryngeal mask anesthesia can provide an airway, but must not be secured due to the risk of aspiration. The need of high doses of inhalation drugs may hinder uterine contractions. The addition of a muscle relaxant will change the patient's respiratory patterns and physiology. Regional anesthesia alone might not be tolerated. A decrease in cough strength, as well as dyspnea, orthopnea, and hyperventilation may be harmful to both the parturient and the fetus. However, we successfully managed this case using epidural anesthesia combined with assisted mask ventilation instead of spontaneous breathing usually provided by a simple mask in almost all American Society of Anesthesiology (ASA) class I-II parturients during cesarean section. The anesthetic level was maintained at T8 with 18 ml of 2% Xylocaine mixed with 2 ml of 7% sodium bicarbonate with 1:200,000 epinephrine epidurally and with the patient in a supine position with the head up at 30 degrees to prevent cephalic spreading and to ensure better pulmonary ventilation.

Adult↗

[Cesarean section in a patient with threatening hemoptysis caused by tracheal carcinoid].

A woman 29 weeks pregnant presented with acute respiratory insufficiency and massive hemoptysis of unknown origin. An emergency cesarean section was performed to avoid hypoxic fetal damage during episodes of maternal hypoxemia. Bleeding was due to an unsuspected endotracheal carcinoid tumor located near the carina. The tumor obstructed the distal portion of the trachea, leading to life-threatening complications during tracheal intubation because of its histological characteristics and placement. Pulse oximetry response to standard mechanical ventilation was unsatisfactory. Special measures to ventilate mother and fetus were successful, in spite of iatrogenic pneumothorax and pneumomediastinum. We report an exceptional case of tracheal carcinoid tumor during the pregnancy and recommend that tracheal or bronchial intubation take place under fiber optic guidance in cases of hemoptysis with no firm etiologic diagnosis.

Adult↗