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The 26-year-old man experienced symptoms of chronic airway obstruction with shortness of breath, cough and wheezing, which primarily led to a diagnosis of asthma bronchiale. Absence of adequate response to antiasthmatic treatment and development of hemoptysis and weight loss led to the tentative diagnosis of upper airway obstruction by tumor. Bronchoscopy revealed adenoid cystic carcinoma of the distal trachea.
A young woman with catamenial hemoptysis and pleuritic chest pain is reported. She had two living children and had undergone three abortions and a tubal ligation followed by menorrhagia and dysmenorrhea. Fiberoptic bronchoscopy revealed no abnormalities, but computed tomograms of the chest revealed bilateral lung densities, which waxed and waned during the menstrual cycle. When characteristic clinical and CT findings are present, bronchoscopy is not necessary for the diagnosis of pulmonary endometriosis.
A 41-year-old man was admitted to our hospital because of hemoptysis and dyspnea. Physical examination disclosed oral ulcer, acne and scrotal ulcer. Although ocular lesions were absent, the needle reaction was positive. Then we diagnosed this case as incomplete type of Behçet's disease. Chest X-ray showed diffuse retinolinear shadows in the entire lung field and an infiltrative shadow in the left middle lung field. CT-scan revealed interstitial shadows in the entire lung field, a wedge-shaped shadow in left S6 and aneurysmic dilatation of the left lower lobe pulmonary artery. Pulmonary angiography showed obstruction and aneurysmic dilatation of the left lower lobe pulmonary artery. Pathological examination of the TBLB specimen revealed thickening of the vessel wall, perivascular infiltrations of mononuclear cells, hemorrhage and slight thickening of alveolar septae. These findings were compatible with pulmonary lesions of Behçet's disease. After administration of corticosteroid, the symptoms and the chest roentgenographic findings improved. Pulmonary lesions of Behçet's disease were discussed.
From Jan 1981 through Oct. 1988, fiberoptic bronchoscopic examination was undertaken in 390 patients with hemoptysis and basically normal chest roentgenogram or prominent pulmonary markings. A diagnosis of malignancy was made in sixteen cases (4.1 percent). The positive rates in was higher in those were heavy smokers or in patients of age greater than 40 years, whose bloody sputum rate were significantly higher than non-smoking patients whose age were less than 40 years, and patients coughed up cupfull of blood intermittently, (P less than 0.005). The absolute indication of bronchoscopic examination in patients with hemopstysis and a basically normal chest X-ray film are those who are greater than 40 years old, heavy smokers, coughing up bloody sputum and no improvement by active treatment for two weeks.
Aspergillosis with fatal outcome are usually pulmonary invasive aspergillosis with or without dissemination, developed in patients with severe immunosuppression. We report a fatal case of bronchial necrotizing aspergillosis in a young woman with diabetes mellitus, who developed similar lesions to "Semi-invasive Aspergillosis", so-called "Chronic Necrotizing Pulmonary Aspergillosis". This aspergillosis was complicated by large pulmonary artery aneurysms requiring an hemostatic lobectomy. These aneurysms, secondary to the bronchial lesions, contrast with infectious aneurysms (so-called mycotic) secondary to septic embols. They differ from Rasmussen's aneurysms, due to tuberculosis, by their size, fusiform shape and extent. Lesions of vessels' walls and parietal fungal invasion in the vicinity of an endo-bronchial aspergilloma explain the vascular rupture. The multiplicity of these aneurysms, showed on C T Scan, is responsible for death by post-surgical recurrence of hemoptysis.
The author's purpose was to evaluate the efficacy of therapeutic embolization in pulmonary hemorrhage performed with fibrin foam (Spongostan) suspended in sclerosing agents (hydroxy-polyethoxy-dodecane 3%, or natrium morruate 5%), and electrocoagulation (Biotrol, spa) as an alternative to surgery. Twenty patients were embolized: 17 with fibrin foam and sclerosing agents only, 2 with the addition of electrocoagulation and a Gianturco coil respectively, and 1 with electrocoagulation alone. The follow-up ranges from 3 to 42 months (average 22). A patient affected by aspergilloma died a few days after hemoptysis. The patient treated by electrocoagulation alone suffers from periodical hematic expectoration (spitting). The remaining 18 patients have not shown any pathological findings. In 2 cases the arterial occlusion was confirmed by angiography, while in 1 case partial arterial recanalization was observed. Such a finding was due to the vessel dimensions and to hyperflux values. In similar cases, obstruction must be completed by different techniques (e.g. Gianturco coils, electrocoagulation, detachable balloons, etc.). The absence of flux resulting from embolization improves electrocoagulation efficiency, which should be considered as the technique of choice. Even though additional trials are needed, the techniques have proven quite reliable and suitable to replace surgery in low-aggression lesions.
The emergency management of hemoptysis requires an organized approach, integrating clinical and radiologic information, to make an accurate diagnosis and to provide the appropriate immediate and followup care. An outline of this approach is diagrammed in the algorithm.
A 44-year-old man presented with massive hemoptysis. Bronchoscopy followed by surgical exploration revealed a left ventriculo-bronchial fistula related to previous ventricular surgery. Repair was successful.
In June 1987, a 20-year-old man was diagnosed as T-cell acute lymphoblastic leukemia. In August, at a nadir period of the remission induction chemotherapy, he complained of high fever and dry cough. A chest roentgenogram also showed a nodular area of increased density in the left upper lobe. Since his clinical state deteriorated progressively despite the administration of broad-spectrum antibiotics, amphotericin B was administered intravenously (with an initial dose of 5 mg/day, increased up to 25 mg/day). Concomitant with bone marrow recovery and continued antifungal therapy, he became soon afebrile and improved over the next 2 months. The infiltrates also began to resolve. Then he abruptly coughed up about 800 ml of blood and suffered from acute respiratory failure. Bronchial arteriographic studies demonstrated active extravasation of contrast medium in the region of the cavity. After therapeutic embolization with Gelfoam, the extravasation was no longer observed. Active bleeding abruptly ceased and had not recurred until the left upper lobectomy which was performed 10 days after the embolization. This case typically demonstrates the value of bronchial arterial embolization in treating massive hemoptysis.
The thoracic localization of endometriosis may involve the pulmonary pleura and the diaphragm, or the bronchopulmonary parenchyma, according to mechanisms which appear to be quite different. The principal clinical manifestations express themselves depending on their localization, a pneumothorax in the first case and hemoptysis in the second. One clinical characteristic, however, applies to them all, a rhythm strictly related to periods. The current methods of visualization of the pleura enable a macroscopic diagnosis to occur in the former cases in 64% and the body scanner now localizes the second in all cases. Treatment by Danatrol is often strikingly effective in a few months, notably in the cases with parenchymal localization.
Neurogenic, or postictal, pulmonary edema is a rare complication of grand mal seizures. At present, the etiology of this disorder is complex and not understood fully. This report describes a case of a young man who was previously healthy, but who subsequently developed acute pulmonary edema after a grand mal seizure. The patient presented with gross hemoptysis, which has not been described previously in this disorder. The pathogenesis, diagnosis, and treatment of neurogenic pulmonary edema are discussed.
Alveolar soft part sarcoma is a rare soft tissue tumor arising in extremities. The universal tendency for late widespread metastasis to lung, bone and brain, make the treatment of this tumor a particular challenge. This time, we performed the intra-arterial infusion of MMC and bronchial arterial embolization by spongel for hemoptysis of this metastatic lung tumor. Rosenbaum has reported the characteristics of angiogram of the metastatic brain tumor. In our case, bronchial arteriography showed the manifest hypervascular pattern "rosary form," "pooling" and "B-P shunt." These findings should yield benefits for the diagnosis and treatment of this metastatic lung tumor.
The authors report a case of hemoptysis occurring after closed chest trauma complicated by spontaneously regressive parenchymatous hematomas. Bronchial arteriography showed systemic hypervascularisation with shunt in the territory of a hematoma which had regressed spontaneously several months previously. The authors mention the rarity of this aetiology and emphasise the value of bronchial arteriography and of embolisation.
A patient had complications of invasive pulmonary mucormycosis. A bronchopleural fistula developed, representing a rare complication of pulmonary mucormycosis. Massive fatal hemoptysis occurred, due to the propensity of mucormycosis to invade blood vessels.
We report a patient with massive hemoptysis due to benign lymphocytic angiitis and granulomatosis complicated by reactivated tuberculosis. There was remarkably good response to treatment with chlorambucil, corticosteroids and antituberculous drugs.
Hemoptysis is an alarming symptom that should not be dismissed lightly. A thorough evaluation will lead to the correct diagnosis in 80 to 90 percent of cases. Surgery is occasionally necessary where life-threatening hemorrhage is present but, more commonly, appropriate therapy can only be determined when the etiology is discovered, thus mandating a careful, thorough diagnostic search.
One case of recurrent pneumothorax, coinciding with menstruation, is documented. The ethiopathogenesis of this syndrome remains unknown, after studying the 44 cases. Their association with pleural endometriosis has only been found in nine cases. This new publication with pleural endometriosis and menstrual hemoptysis supports an endometriosis etiology. The surgical treatment of pneumothorax is effective, and a main disclosure of this syndrome would facilitate the research and enlightenment of the ethiopathogenesis.
A 4-year-old Filipino girl, a recent immigrant to Hawaii, had hemoptysis, and a chest roentgenogram disclosed diffuse infiltrates of the right lung. Microscopic examination of a morning gastric aspirate showed numerous golden-brown, operculated ova, and microscopic examination of sputum and stool specimens confirmed these ova to be those of the lung fluke, Paragonimus westermani. She responded favorably to bithionol therapy and was asymptomatic and growing normally 2 1/2 years after therapy.