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PubMed2003

[Management of massive hemoptysis: current role of interventional endoscopy].

Massive hemoptysis represent a very serious pathology and a vital threat for the patients. In spite of the availability of several therapeutical tools, the prognosis remains dark: mortality more than 60%. We expose here, the pathophysiological mechanisms of this severe complication and the main predisposing conditions and etiologies, to then approach the contribution of new endobronchial interventional treatments. The flexible endoscopy allowing only limited acts like the instillation of adrenalin and physiological solution at 4 degrees C, can in some cases contribute to probe or endobronchial catheter installation or intubation. The rigid bronchoscopy finds in massive hemoptysis a vast field of action and will make possible to better control the bleeding and to ensure the hemostasis: thermocoagulation, laser and cryotherapy aim at the same time stopping the haemorrhage and allow specific treatment. Their results are different according to the technique. The endovascular and surgical procedures have a complementary role.

Bronchoscopy↗
PubMed2003

[Moderately abundant hemoptysis revealing endobronchial hamartochondroma].

Hemoptysis is rarely the inaugural sign of endobronchial hamartoma. Abundance may range from moderate to massive, and may be life-threatening. We report the case of a 44-year-old woman who was referred to our center with moderate and persistent hemoptysis. A left upper lobe lobectomy was performed. We discuss the therapeutic options in such cases.

Adult↗
PubMed1992

[Emergency lung resection in patients with massive hemoptysis].

Emergency lung resection was done in 32 patients with massive hemoptysis. The morbidity and mortality rates were 18.75% and 6.25% respectively. Problems about how to find the focus of hemoptysis, when to perform the operation, how to select anaesthesia, operative techniques and limits of lung resection were discussed.

Adolescent↗
PubMed1992

[Arteriography and bronchial artery embolization for massive hemoptysis in 100 cases of tuberculous].

Bronchial arteriography and embolization with sponge gelatin were performed in 100 tuberculous patients of massive hemoptysis. Three direct signs and other six indirect ones were found in arteriographies, Those signs were roentgenographic abnormalities for defining bleeding sites. 100 massive hemoptysis cases were treated with sponge gelatin embolization in bronchial artery. The results are satisfactory, the success rate were 92.9%, 87.4% and 79.0% at one week, one month and three months respectively. The advantages of arterial embolization and the reasons of failures were discussed in this paper.

Bronchial Arteries↗
PubMed2003

[A case of bronchial arterial aneurysm associated with recurrent massive hemoptysis].

A 69-year-old man was admitted to our hospital because of massive hemoptysis. Bronchial arteriography showed no abnormal findings. Bronchoscopic findings revealed a small, reddish elevated lesion on the posterior surface of the left upper lobe bronchus. Since the patient developed massive hemoptysis four times in a month, he underwent ligation and transection of the left bronchial artery, and bronchoplasty. Histopathologically, the resected tissue showed a bronchial arterial aneurysm without any inflammatory changes. We concluded that the aneurysm had developed in a malformed vessel.

Aged↗
PubMed1992

[A case of interstitial pneumonitis with hemoptysis, BOOP (bronchiolitis obliterans organizing pneumonia) pattern, granulomas and foreign body giant cells in lung biopsy].

A 66-year-old male presented to our hospital in January 1990 with chief complaints of hemoptysis and cough. These symptoms had developed 10 months previously and had gradually increased. Fine crepitations were audible over the right lower lung field. There were no results suggesting an inflammatory process such as leucocytosis, elevation of ESR or positive CRP reaction. Chest X-ray film on the first visit showed fine nodular shadows in the right lower lung field, and chest CT revealed fine nodular shadows and mild dilatation of the right lower lobe bronchus. Transbronchial lung biopsy specimens showed granulomas with multinucleated giant cells, alveolitis and Masson bodies. The open lung biopsy specimens showed numerous macrophages and foreign body giant cells, and extensive organizing exudates in the bronchioles and alveolar spaces. Proliferation of smooth muscle and fibrosis around the dilated bronchioles were also seen. Thus, this patient demonstrated BOOP pattern, with granulomas and foreign body giant cells. His hemoptysis appeared to have resulted from inflammation of dilated bronchioles. His symptoms and abnormal shadows on chest X-ray improved without any therapy after admission. After treatment with corticosteroid, the diffuse fine nodular shadows disappeared. There has been no recurrence of symptoms to date, although this patient has continued living in the same environment as prior to admission. BAL findings during his prolonged follow-up revealed decrease in lymphocytes and elevation of CD4/CD8 ratio. Although the presence of granulomas suggests the possibility of an allergic reaction, no antigenic material could be identified in this case.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Postmortem computed tomographic (PMCT) demonstration of fatal hemoptysis by pulmonary tuberculosis--radiological-pathological correlation in a case of rupture of Rasmussen's aneurysm.

We report a case of fatal hemoptysis resulting from the rupture of a Rasmussen's aneurysm. Postmortem computed tomography (PMCT) clearly showed the air-fluid level within a tuberculous cavity and fluid-filled trachea. In this case, PMCT was useful as a screening tool to detect the cause of death as asphyxia from hemoptysis. It became a guideline for the following autopsy, as well as evidence to explain the importance of autopsy to the family.

Aneurysm, Ruptured↗
PubMed2004

[Bronchioloalveolar carcinoma with acute respiratory failure due to hemoptysis; report of a case].

A 69-year-old male was admitted to our hospital for hemoptysis and dyspnea. Because of his deteriorating respiratory distress, he was intubated and controlled by respirator for 3 days. He was diagnosed with adenocarcinoma of the lung by the sputum examination and chest computed tomography (CT) revealed an infiltration shadow in the peripheral superior ventral segment (S3) of the right upper lobe. He underwent right upper lobectomy with video-assisted thoracic surgery. Microscopic findings of the resected specimen measuring 10 x 10 x 7 cm revealed mucin-producing bronchioloalveolar carcinoma (BAC) with metastases in lymph nodes and the same lobe (S2b). We reported a rare case of BAC with hemoptysis.

Acute Disease↗
PubMed2004

[An adult congenital bronchoesophageal fistula with massive hemoptysis; report of a case].

A 67-year-old female was referred to our hospital because of bronchoesophageal fistula detected by upper gastro-intestinal series for cancer screening. The patient has had a history of coughing on liquid ingestion since childhood and she has been hospitalized 4 times for treatment of pneumonia during the past 20 years. While waiting the treatment, she was emergently admitted to the hospital because of massive hemoptysis. Transcatheter embolization of feeding arteries including the right inferior phrenic artery successfully controlled her hemoptysis. After reembolization of the feeding arteries for preventing massive hemorrhage during operation, posterolateral thoracotomy was performed. Surgical findings disclosed the bronchoesophageal fistula without inflammatory changes. She underwent fistulectomy combined resection of the middle and lower lobes which were destroyed by the repeated pneumonia. This case was considered type I congenital bronchoesophageal fistula according to Braimbridge and Keith classification because of the presence of diverticular projection which connected to the bronchus. Early diagnosis and rapid treatment are thought to be important for treating this disease.

Aged↗
PubMed2004

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 emergent pneumonectomy for massive hemoptysis from destroyed lung in a patient with previous thoracoplasty. After prolonged ventilation support postoperatively, the patient with compromised lung function recovered well.

Aged↗
PubMed1992

Pathogenesis, evaluation, and therapy for massive hemoptysis.

Massive hemoptysis is a rare, but life-threatening event. Death from massive hemoptysis is usually due to aspiration of blood. Thus, the initial evaluation should occur simultaneously with efforts to control the patient's airway and respiratory status. Therapeutic interventions can be directed with an understanding of the underlying pathophysiology and estimated rate of blood loss. Surgery remains the definitive therapy. However, more conservative measures can usually control acute bleeding and provide therapeutic alternatives for patients who are not surgical candidates.

Adult↗
PubMed2005

A pheochromocytoma causing limited coagulopathy with hemoptysis.

We treated a 59-year-old woman presenting with hemoptysis, a rare symptom of pheochromocytoma. Multiple factors including hypertension caused by sudden catecholamine release may result in pulmonary edema. It should be noted that the increased activation of coagulation cascade, which was demonstrated by increased thrombin-antithrombin III complex (TAT) and prothrombin fragment factor 1 and 2 (F1 + 2), as well as endothelial or platelet stimulation evidenced by the increased plasma von Willebrand factor, may have contributed to hemoptysis. These abnormalities were normalized after adrenalectomy. Our case indicates the important role of catecholamine in coagulopathy and possibly in vasculopathy.

3-Iodobenzylguanidine↗
PubMed2005

[Pulmonary large cell carcinoma contiguous to bullae with massive bullous hematoma and hemoptysis; with special reference to 20 cases of Japanese reports].

A 50-year-old man with continuous hemosputa and large hematoma of left upper lobe contiguous to bilateral emphysematous bullous disease was admitted for surgery to stop hemorrhage and to resect left lung hematoma and multiple bullae. Bullectomy and neodymium yttrium aluminum garnet (Nd-YAG) laser irradiation to bullae of left upper lobe performed successfully with maximum preserved pulmonary function of it. Pathological examination, however, revealed anaplastic carcinoma inside bulla of S(1+2)c with minimal invasion into adhered parietal pleura (p 3). Left upper lobectomy was carried out with complete mediastinal lymph node dissection (ND 2 b). The final pathological diagnosis was large cell carcinoma of left S(1+2)c with the staging pT3N0M0 and stage II. The patient lives actively in daily life more than 7 years without any recurrence. Clinical analysis of Japanese 20 cases of lung carcinoma with initial signs of hemosputa and/or hemoptysis contiguous to emphysematous bullae elucidate following important facts. Hemosputa and hemoptysis play important role for early finding and diagnosis of lung cancer contiguous to bullous disease, especially in patients of early clinical stage with or without computed tomography (CT) exams and promise to better surgical prognosis and survivals as compared with non hemosputa ones.

Blister↗
PubMed1992

[A case of intractable hemoptysis due to malignant hemangioendothelioma].

A 65-year-old man who died of respiratory failure due to malignant hemangioendothelioma is reported. He was admitted to our hospital because of intractable hemoptysis. Chest roentgenogram revealed multiple patchy shadows in both lungs, but we could not make a diagnosis by usual clinical examinations including transbronchial lung biopsy. Since the patient's condition became critical, oxygen therapy, anticoagulants and antibiotics were started. In addition, corticosteroid therapy and double filtration plasmapheresis were performed since immunological disorder was suspected because of positive immunological examinations such as antinuclear antibodies and an increase in circulatory immune complexes. There was little response to the treatments and the patient finally died of respiratory failure. At autopsy, multiple tumor nodules were found throughout the lungs and the liver. Metastasis to mediastinal lymph nodes was also discovered. These findings made it impossible to confirm the primary lesion. Microscopy showed proliferation of anastomosing capillaries encasing tumor cells of unknown origin. Silver staining demonstrated capillaries encompassing the atypical cells, suggesting a vascular origin of the tumor. Furthermore, factor VIII related-antigen in the tumor cells was confirmed by the peroxidase-antiperoxidase (PAP) method. The final diagnosis of malignant hemangioendothelioma was made from these histological findings. Malignant hemangioendothelioma is rare, but is an important cause of intractable hemoptysis.

Aged↗
PubMed2006

[Suturing left main bronchus in difficult lung resection for repeated and massive hemoptysis].

A 79-year-old man with repeated and massive hemoptysis due to bronchiectasis was admitted to our department for surgery. The patient had undergone left upper lobectomy for pulmonary tuberculosis, and descending aortic replacement for Stanford type B aortic dissection. The patient underwent occlusion of the left main bronchus by suturing through median sternotomy. The reasons we did not choose completion pneumonectomy were advanced age, poor physical condition immediately after hemorrhagic shock, and the difficulty of performing pneumonectomy due to previous surgery and anastomotic aneurysm of descending aorta. The postoperative course was uneventful and the patient left the hospital on the 16th postoperative day. The patient did not develop pneumonia or empyema thereafter, but died suddenly of unknown etiology 1.5 years postoperatively. Lung exclusion by suturing a bronchus is thought to be a useful alternative for repeated and massive hemoptysis without pneumonia in a case of difficult lung resection.

Aged↗
PubMed2006

[Bronchial artery embolization as a treatment for massive hemoptysis. A case report].

A 47 year old male was admitted to the pulmonary medicine department in Landspítali University Hospital following a three day episode of massive hemoptysis but prior to admission he had been suffering from a dry cough for several weeks. Neither bronchoscopy nor a CT scan revealed the cause of bleeding and he was treated for bronchitis. Subsequently the bleeding stopped and he was discharged on Friday for a follow-up bronchoscopy to be performed three days later but only for that study to reveal continued bleeding and he was therefore readmitted. Two days later a selective bronchial arteriography was performed, showing vascular hyperemia and a bleeding site which was treated accordingly with endovascular embolization. Hemoptysis has not recurred on follow-up.

Bronchial Arteries↗
PubMed2006

[Small peripheral lung cancer incidentally detected by massive hemoptysis].

A 47-year-old man was admitted to our hospital for treatment of massive hemoptysis. He was intubated and underwent bronchial arterial embolization because of this deteriorating respiratory state and uncontrollable hemoptysis. Computed tomography (CT) of the chest showed a 1-cm nodular shadow in the peripheral apical lobe (S1) of the right lung. He underwent right upper lobectomy for the purpose of preventing re-hemorrhage as well as making the definitive diagnosis of nodular shadow in S1 of the right lung. Intraoperative pathological examination revealed the nodule as adenocarcinoma, and mediastinal lymphadenectomy was added to the right upper lobectomy. The patient recovered uneventfully, and there has been no sign of recurrence for 15 months after the operation.

Adenocarcinoma↗
PubMed2005

[Recurrent hemoptysis following thienopyridines and amiodarone administration. therapeutic dilemma].

The authors describe a case of a 74-year-old man with advanced coronary heart disease in whom pulmonary hemorrhagic complications during therapy with ticlopidine and subsequently with clopidogrel and amiodarone were observed. Fever and massive hemoptysis following five days of ticlopidine treatment, before elective coronary angiography, were noticed. Transient interstitial X-ray changes of the right lung were visible. Three months later a new episode on the third day of clopidogrel administration was manifested. He was after PCI, performed because of ACS complicated with ventricular fibrillation. Two days following clopidogrel discontinuation hemoptysis remitted but after ten days occurred again (this time with bilateral X-ray changes). Amiodarone, given after VF, was stopped. Spectacular improvement with steroid treatment was observed. Indobufen (reversible COX- 1 inhibitor) as an antiplatelet therapy was availed. The authors discuss therapeutic dilemma concerning the patient with coexisting different diseases.

Aged↗