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The case of a young girl with severe hemoptysis in a Kartagener's syndrome is described. Because bronchoscopy failed to locate the origin of the bleeding, preoperative angiography was performed. The patient was treated by resection of the middle lobe. The bronchus wall was located as the origin of bleeding.
Xanthogranulomatous pyelonephritis is a renal inflammatory process associated with chronic obstruction and renal calculi. A patient with xanthogranulomatous pyelonephritis presented with the acute onset of hemoptysis and a lung mass. At thoracotomy the mass was resected and found to be a renal calculus embedded within inflammatory tissue.
Massive hemoptysis is an uncommon but life-threatening emergency. The loss of at least 600 mL of blood within a 48-hour period has been associated with a high mortality rate. Initial stabilization including airway and ventilation management, IV fluids, oxygen, and laboratory and radiographic studies should be done in the ED. Bronchoscopy and angiography are initial diagnostic manuevers that also may be therapeutic. Surgical therapy is reserved for patients with adequate pulmonary reserve and localized sources of bleeding.
Advances in technology have increased the contribution of radiology in understanding and evaluating diseases of the airways. In patients with hemoptysis, CT is now established as a complementary technique to bronchoscopy, or as an alternative to bronchoscopy in selected cases. The introduction of high-resolution CT has improved the detection and assessment of bronchiectasis and small airways disease, allowed better correlation between pathologic changes and radiologic appearances, and provided new insights into possible links between small airways disease and bronchial disease.
Mounier-Kuhn syndrome--or tracheobronchomegaly--is a rare congenital disorder characterized by significant dilation of the trachea and main bronchi. It is accompanied by ineffective cough and is often complicated by recurrent lung infections and bronchiectasis. Clinical presentation varies widely, ranging from forms with scarce involvement of functional capacity to others that progress to respiratory failure that can prove fatal. We report an exceptional case of massive hemoptysis secondary to the presence of pulmonary aspergillomas and bilateral bronchiectasis in which bronchial arteriography with embolization and surgical resection were insufficient for resolving the complications.
Fallot tetralogy with pulmonary artery atresia is a special situation in which the patient can survive up to middle-age. In these cases some complications such as hemoptysis can appear with difficult treatment that endangers the life of the patient. When the cause of bleeding is the arteriovenous shunts, which are frequent in the multiple vascular malformations originated in this congenital cardiopathy, the selective embolization of these malformations can be an effective option of treatment.
We report the case of a 32-year-old man with a mycotic aneurysm of the left subclavian artery. This patient had immunosuppression caused by chemotherapy administered for treatment of leukemia. This aneurysm was revealed by two episodes of hemoptysis caused by a lung parenchyma fistulization. The patient was treated successfully by simple ligation and exclusion via a thoracotomy with partial lung resection. Histologic examination confirmed the presence of aspergilloma filaments in the false aneurysm. We suspect that aspergilloma could have been the cause of the mycotic aneurysm in this particular case. The literature on subclavian artery mycotic aneurysms is reviewed.
The authors describe the case of a man, 46 years old, former smoker, former bird breeder, followed in the service of Imunoallergology for bronchospasm without response to the treatment. After experiencing an hemoptysis he was admitted in our service. He was submitted to many exams, which include a flexible bronchoscopy. This technique allows the identification of an endobronquial necrotic mass, which almost obstructed the main right bronchus. In order to obtain a bigger and more representative sample a rigid bronchoscopy was performed. This technique showed a broncholith, which was partially removed, and a bronchial fistula. Actually he is assimptomatic and under annual surveillance. First described for Aristoteles, the broncholithiasis is defined by the presence of stones in the bronchial tree. It is a very rare pathology, with a variable clinical expression, which must be considered whenever there is respiratory complaints in association with hilar or mediastinic calcifications.
Hemoperitoneum caused by ruptured hepatocellular carcinoma (HCC) is not uncommon in patients with HCC. Hemothorax due to rupture of metastatic HCC, however, is a very rare complication with high mortality because of uncontrollable hemorrhage. We describe a 42-year-old male HCC patient with chest wall metastasis complicated by hemothorax with an unusual presentation of massive hemoptysis. He received tube thoracotomy immediately and emergency surgery because of persistent bleeding. Hemostasis was achieved transiently. Despite intensive care, he died of multiple organ failure on the 6th postoperative day. We conclude that hemothorax due to a ruptured HCC, as in this case, indicates a very poor prognosis despite intensive treatment.
Hemoptysis in children are infrequent and often self-limiting. They are a manifestation of the broader spectrum of pulmonary haemorrhage. Diffuse pulmonary haemorrhages are often associated with diseases of other organs (cardiopathies, systemic diseases). Focal haemorrhages have multiple aetiologies, dominated by bronchopulmonary infections and cystic fibrosis. Fiberoptic bronchoscopy allows one to localise the bleeding, look for local causes and diagnose pulmonary hemosiderosis by BAL. For local lesions and if the medical management fails, bronchial arteriography is indicated to perform the embolisation of the bleeding vessels.
In this paper, we present a case history, involving a 70-year-old male patient with hemoptysis due to an accessory cardiac bronchus, which was treated successfully by resection.
Bronchogenic cysts result from congenital disorders, are often asymptomatic at diagnosis, but complications are not uncommon. We report the case of a 19-year-old woman with severe hemoptysis. This rare presentation of an intrapulmonary bronchogenic cyst should be considered as differential diagnosis in patients with cavernous lesion of a lobe. Surgery was performed as a diagnostic and therapeutic measure.
Bronchial artery embolization was performed in two patients with anomalous origins of the bronchial artery. In one patient, the anomalous bronchial artery originated from the convex surface of the aortic arch between the origins of the brachiocephalic and left carotid arteries, while in the other, it originated from the internal mammary artery. Anomalous bronchial arteries represent a potential pitfall during bronchial artery embolization. Radiologists involved in embolotherapy for hemoptysis should therefore be alerted to the possible presence of anomalous bronchial arteries, especially when significant bronchial artery supply to areas of abnormal pulmonary parenchyma is not demonstrated at a catheter search or aortography of the descending aorta. In these instances, arch aortography should be performed to identify anomalous origins of the bronchial arteries or other nonbronchial systemic collateral vessels.
Aortobronchial fistula is a rare but serious cause of hemoptysis. It can develop from an aneurysm of the descending thoracic aorta in the context of infections or it may appear as a sequel of surgical repair of congenital heart defects. Presenting symptoms include mild bronchial hemorrhages and recurrent chest pain, culminating in a normally fatal massive hemorrhage. Diagnosis by imaging is not always conclusive and clinical suspicion based on medical history is essential. Surgical placement of an endovascular stent graft is the treatment of choice. Post-surgical prognosis is good although there is a risk of recurrence in the case of superinfection.
A 38-year-old man presented with massive hemoptysis followed by hemorrhage shock. The patient's history revealed a Dacron patch repair for aortic coarctation and recoarctation carried out twice, once 23 and once 10 years ago. Diagnosis of a ruptured descending aortic aneurysm with an aortobronchial fistula into the left lower lobe was established using CT scan. Emergency surgery consisted of left pneumonectomy and descending aortic graft replacement during deep hypothermic circulatory arrest. The patient was discharged 12 days later.
Angiosarcomas are rare tumors, and primary pulmonary location has only been reported in very few cases. In the present report a patient with severe, intractable hemoptysis, demanding pneumonectomy, was found to have a single, small angiosarcoma eroding a large bronchus. No sign of tumor-spread to other organs was detected. A review is made of previous reports of angiosarcomas of the lung, and the differential diagnoses are discussed.
We report a case of fatal rupture of a false aneurysm of the ascending aorta during aortographic injection. The aneurysm had formed at the site of aortic cannulation done for a cardiac bypass at an earlier date. The rupture manifested as hemoptysis as the false aneurysm had burrowed and ruptured into the anterior segment of the right upper lobe of the lung.
A 53-year-old woman presented with a productive cough, fever, chills, and night sweats of one month's duration. She reported having had lightly blood-streaked sputum initially but then experiencing massive hemoptysis (> 200 mL/2 hr). Since the onset of symptoms, she had had malaise, body aches, and a 27-lb weight loss. For the last two weeks, she had also had increasing shortness of breath and pleuritic chest pain.