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A 57-year-old woman with squamous carcinoma of the right lung (hilum) developed acute massive hemoptysis with syncope and hypotension. Resuscitation was complicated by the development of massive systemic air embolus, and the patient died.
In seven patients with nonmalignant disease, we bronchoscopically observed various types of bronchial arterial lesions that may have caused hemorrhage. Five of the seven showed a bulging lesion, and the other two demonstrated an intrabronchial mass. We also examined these seven patients using selective bronchial arteriography. Herein we report our comparative study of the bronchoscopic findings and the bronchial arteriograms of these bronchial arterial lesions. The bulge observed in bronchoscopy corresponded either to an aneurysm or to a hypervascular area in the bronchial arteriogram. The mass lesions corresponded to a hypervascular area or a focal dilatation in the bronchial arteriogram. The intrabronchial lesions observed bronchoscopically either disappeared or were significantly diminished by bronchial arterial embolization for management of the hemorrhage. A histologic examination in two patients who underwent surgery revealed vascular lesions corresponding to the intrabronchial lesions in bronchoscopy. The results of this comparative study have important application in the bronchoscopic examination of bronchial arterial lesions in patients with hemoptysis.
Plastic double-lumen endobronchial tube was used to maintain the airway in a patient with massive hemoptysis and nonresectable lung cancer. This tube is superior to the previously used Carlens tube, as it can be inserted in emergency situations and does not require surgical setting. In addition, the larger internal diameter of these tubes allows better airway clearance and passage of a flexible bronchoscope. The double-lumen tube may be considered as an alternative to selective main-stem intubation.
Left ventricular aneurysm is a common sequela of anterior myocardial infarction. At the time of coronary artery bypass grafting, resection of this aneurysm is frequently undertaken to alleviate symptoms of heart failure and/or refractory ventricular tachycardia. Complications related to aneurysmectomy are uncommon. We describe an unusual patient who presented with hemoptysis related to the formation of a pseudoaneurysm which communicated with the lung parenchyma. The etiology of the pseudoaneurysm formation was an indolent, slow-growing infection.
Sexual activity increases physiologic demands on the cardiovascular system. A patient with stable angina pectoris experienced recurrent bouts of hemoptysis caused by left ventricular failure that occurred only during sexual activity. Severe atherosclerotic coronary vascular disease was confirmed by cardiac catheterization. The patient underwent successful coronary artery bypass grafting; nine months after surgery, he is sexually active and symptom-free.
A 79-year-old man was hospitalized because of staphylococcal sepsis, and subsequently died from massive hemoptysis. Autopsy revealed a lung abscess which had eroded into the aorta. Severe atherosclerosis of the aorta may have been an important contributing factor.
Percutaneous cannulation of the internal jugular vein is commonly performed to obtain central venous access. We report the first case of massive hemoptysis occurring during cannulation of the internal jugular vein.
A 79-year-old retired schoolteacher had a history of bronchiectasis. She developed recurrent hemoptysis requiring multiple blood transfusions. Exophiala dermatitidis was cultured repeatedly from bronchial lavages. To our knowledge, this is the first documented case of isolated pulmonary phaeohyphomycosis due to E dermatitidis, and it was successfully treated with amphotericin B and 5-fluocytosine.
In three patients with hemoptysis, fibrin precursors were sprayed into the bronchus selectively to the site of the bleeding. In this way, four hemoptyses, resistant to other therapy, were arrested without any adverse effect. The total loss of blood was estimated at least 9 L, and it was substituted by transfusion of more than 8 L. The new method is described and its possible modes of action are discussed. This selective intrabronchial local coagulative method may be the proper symptomatic treatment of choice if causal therapy is ineffective or not available for any reason.
Although amebiasis is prevalent in tropical and subtropical areas, it occurs sporadically in the United States. Pleuropulmonary involvement is seen in about 20 percent of the patients with amebic liver abscesses. We describe a patient with pleuropulmonary amebiasis who complained of hemoptysis but had no gastrointestinal symptoms. This rather unusual presentation caused a considerable delay in securing the diagnosis.
A 69-year old Japanese woman with hypertension was admitted because of continuous back pain and recurrent hemoptysis. Radiographic findings showed an enhanced irregular mass, at the aortic arch fed by the tracheal artery, which implied both a penetrating aortic atherosclerotic ulcer and lung cancer. Diagnostic surgery revealed no evidence of cancer but did reveal a rupture of the intima at the distal part of the aortic arch. It is assumed that the transmural oozing occurred after development of the penetrating aortic ulcer, which formed an extra-aortic hematoma and caused surrounding inflammation, and led to tracheal artery feeding. The intramural hematoma might have weakened vascular wall tension from the aorta, and formed an oozing extra-aortic hematoma instead of an acute rupture.
OBJECTIVE: In this pictorial essay, we show the usefulness of MDCT angiography for visualization of the bronchial and nonbronchial systemic feeder vessels responsible for hemoptysis. CONCLUSION: By providing thin-section transaxial, multiplanar reconstruction, and 3D images, CT angiography using MDCT allows comparable or better images than conventional angiography with respect to the depiction of bronchial or nonbronchial systemic arteries. CT angiography is particularly useful for visualizing the ectopic origin of bronchial arteries and nonbronchial systemic collateral arteries.
A 58-year-old woman with acute myelogenous leukemia in complete remission underwent successful pulmonary resection for massive hemoptysis occurring after resolution of pulmonary aspergillosis. Despite the fact that the role of surgery in the treatment of pulmonary mycosis in immunocompromised hosts is still to be clearly defined, emergency lung resections can be successfully performed in this group of patients with almost immediate recovery of stable clinical parameters. Brisk recovery can reduce overall morbidity and mortality and allow for early resumption of any necessary treatment for underlying disease.
Endobronchial balloon tamponade is an alternative method that can be used to control massive hemoptysis. Several different techniques have been used for this purpose. We describe a new parallel method, in which biopsy forceps introduced through a bronchoscope channel is used to grasp a balloon catheter. As the bronchoscope is advanced to the bleeding site, the balloon catheter is pulled into position, and subsequently inflated. There are several advantages of this technique. It needs no specialized catheter or guide wire, the procedure is relatively easy to perform, and applicable to other purposes such as introduction of an additional suction catheter.
The effectiveness of percutaneous embolotherapy in cases of hemoptysis due to pulmonary tuberculosis from increasing severity of lung parenchymal injury was compared. The pattern of pleural involvement, as seen on chest radiography and angiography, were comparatively analyzed in 230 patients who were available for follow-ups from March 1992 to December 2003. Chest radiography findings were classified into 4 types based on levels of complicated lesions and pleural involvement. Angiography findings were divided into 4 groups based on the level of blood supply to lesions. Early hemostasis with respect to radiographic group were as follows: Type I- 92% (73/79), Type II- 80% (52/65), Type III- 70% (42/60), and Type IV- 56% (52/92); there was an average success rate of 73% (219/296), and continued hemostasis was found in 80% of Type I patients (62/77), 77% of Type II patients (41/53), 62% of Type III patients (25/40), and 45% of Type IV patients (27/60), with an average long- term hemostatic rate of 67% (155/230). Increasing severity of pleural involvement and associated complications correlated with increasing development of systemic collateral arteries other than the bronchial artery. The severely increased circulation in systemic collateral arteries makes it difficult to predict good hemostatic results following embolization. Therefore, we recommend aggressive treatment, such as surgical intervention, after embolization in such instances.
Thoracic endometriosis is rare. Its associated clinical syndromes should be considered in menstruating women with pneumothorax or hemoptysis. The availability of chest CT scanning and danazol provide new technique in diagnosis and therapy.
The duration of anamnesis and its dependence on the amount of expectorated blood and on concomitant complaints was evaluated in 774 patients examined for hemoptysis in the Department of Respiratory Diseases and Tuberculosis, Faculty Hospital, Brno, with the aim to detect the factors hastening the visiting the physician by the patient. The longest anamnesis in average was in patients with COPD (123 days) and lung cancer (58 days). The patients coming too late to the physician originated mostly from these 2 groups as well--the anamnesis was longer than 2 months in 27% out of COPD patients and in 25% out of cancer patients. After including the influence of the amount of expectorated blood and of the concomitant complaints, the conclusion was reached that the bloody expectoration alone especially when streaks of blood only are present in sputum represent in many patients the motive not important enough for consulting the physician.
Aspiration of foreign bodies is more common in children than adults. The clinical and radiological findings between these two age groups are different. It is a clinical diagnosis often overlooked in adults. We hereby present an elderly male patient who was referred to us due to a one year history of hemoptysis. He was heavy smoker, so the initial working diagnosis was malignancy. Upon bronchoscopic evaluation, a foreign object was found which is very uncommon in adults. The unusual location of the aspirated material is another interesting feature of our case. Clinicians should be aware that aspiration of foreign objects may occur also in adults.