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Pulmonary Hemorrhage

Lung Hemorrhage


Presentation

  • CASE PRESENTATION: A 15-year-old South Asian boy presented with high grade fever, epigastric discomfort and was anicteric on admission.[ncbi.nlm.nih.gov]
  • We describe the youngest patient with this presentation reported to date, a 14-year-old male, who presented with end stage renal disease and pulmonary hemorrhage and was found to have IgA nephropathy by renal biopsy and pulmonary capillaritis by open[ncbi.nlm.nih.gov]
  • A patient with cryoglobulinemia who presented with hypoxic respiratory failure attributed to pulmonary hemorrhage is reported.[ncbi.nlm.nih.gov]
  • Major aortopulmonary collateral arteries can influence the postoperative course of arterial switch operation, with heart failure being the common clinical presentation.[ncbi.nlm.nih.gov]
  • Abstract The combined clinical presentation of acute renal failure with pulmonary hemorrhage is known as pulmonary-renal syndrome. We describe a case of an 84-year-old woman who presented with acute renal failure and pulmonary hemorrhage at onset.[ncbi.nlm.nih.gov]
Fever
  • Dengue hemorrhagic fever should be considered in the differential diagnosis of diffuse pulmonary hemorrhage.[ncbi.nlm.nih.gov]
  • A 10-year-old girl with fever, edema, rash and joint pains, who later developed deep venous thrombosis (DVT), stroke, thrombotic microangiopathic hemolytic anemia and pulmonary hemorrhage.[ncbi.nlm.nih.gov]
  • Discussion: As per WHO guidelines, our patient fulfilled criteria for DHF: fever of 2-7 days,hemorrhagic tendencies, echhymosis and hemoptysis, thrombocytopenia 100,000 and other signs of dengue fever like leucopenia and positive IgM.[erj.ersjournals.com]
  • We reported a patient who presented with fever hemoptysis from diffuse pulmonary hemorrhage, and acute renal injury. Renal biopsy revealed IgAN concomitant with AIN which was the cause of renal dysfunction.[ncbi.nlm.nih.gov]
  • CASE PRESENTATION: A 15-year-old South Asian boy presented with high grade fever, epigastric discomfort and was anicteric on admission.[ncbi.nlm.nih.gov]
Down Syndrome
  • Another case of a 4year-old female child with Down's syndrome diagnosed as IPH for over one year and treated with oral corticosteroids for maintenance therapy. She sudden suffered severe hypoxemia with rapid falls in the hemoglobin level.[ncbi.nlm.nih.gov]
Hemoptysis
  • He had experienced recurrent episodes of massive hemoptysis after epileptic seizures since the age of 28 years. He was admitted to Kyoto University Hospital with massive hemoptysis and hypoxia after an epileptic seizure of a few minutes' duration.[ncbi.nlm.nih.gov]
  • Major hemoptysis a potentially life-threatening condition in pulmonology and can originate from both identifiable and unidentifiable sites.[ncbi.nlm.nih.gov]
  • The patient developed massive hemoptysis despite of marked tumor shrinkage achieved by bevacizumab-containing chemotherapy. Emergency flexible bronchoscopy for hemoptysis suggested that the location of the primary tumor was the source of bleeding.[ncbi.nlm.nih.gov]
  • Hemoptysis from diffuse pulmonary hemorrhage is a rare manifestation in IgAN. We reported a patient who presented with fever hemoptysis from diffuse pulmonary hemorrhage, and acute renal injury.[ncbi.nlm.nih.gov]
  • Gov't MeSH terms Case-Control Studies Ductus Arteriosus, Patent/complications* Ductus Arteriosus, Patent/diagnostic imaging Ductus Arteriosus, Patent/epidemiology Echocardiography Female Follow-Up Studies Gestational Age Hemoptysis/epidemiology Hemoptysis[ncbi.nlm.nih.gov]
Dyspnea
  • Pulmonary manifestations of cryoglobulinemia are uncommon and their clinical behaviour is unpredictable, ranging from mild dyspnea to life-threatening presentations.[ncbi.nlm.nih.gov]
  • He complained of dyspnea and hemoptysis while he was treated with steroids for gastroenteropathy associated with Schönlein-Henoch purpura.[ncbi.nlm.nih.gov]
  • Herein, we report the case of a 31-year-old woman with a 10-year history of discoid lupus, now presenting with dyspnea and pleuritic chest pain of 1 month's duration.[ncbi.nlm.nih.gov]
  • He had a 10 pack-year history of cigarette smoking and quit about one month before presentation due to his progressive dyspnea. He used alcohol on the weekends, but did not use illicit drugs.[the-rheumatologist.org]
  • Most patients present with dyspnea, cough, hemoptysis, and new alveolar infiltrates on chest imaging. Diagnostic tests are directed at the suspected cause.[merckmanuals.com]
Rales
  • On exam, the patient is diaphoretic and has diffuse bilateral rales in all lung zones. The remainder of the exam is unremarkable. Laboratory tests demonstrate a white blood cell (WBC) count of 36.4, a hemoglobin (Hgb) of 13.1, and a lactate of 2.9.[emdocs.net]
  • Sudden tachycardia, tachypnea, hypoxemia, cough, and hemoptysis appeared in the immediate postoperative period, and the patient was transferred to the intensive care unit (ICU) with respiratory failure and generalized coarse rales on admission.[jintensivecare.biomedcentral.com]
Coarse Rales
  • Sudden tachycardia, tachypnea, hypoxemia, cough, and hemoptysis appeared in the immediate postoperative period, and the patient was transferred to the intensive care unit (ICU) with respiratory failure and generalized coarse rales on admission.[jintensivecare.biomedcentral.com]
Hypertension
  • Resolution of pulmonary hemorrhage despite anticoagulation while on extracorporeal membrane oxygenation can occur after relief of left atrial hypertension.[ncbi.nlm.nih.gov]
  • We report the intraoperative diagnosis and surgical management of pulmonary hemorrhage in 3 patients after pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension.[ncbi.nlm.nih.gov]
  • A newborn with persistent pulmonary hypertension and a large persistent ductus arteriosus and open foramen ovale presented with hypoxemia and progressive right heart failure shortly after birth, requiring veno-arterial extracorporeal membrane oxygenation[ncbi.nlm.nih.gov]
  • Susceptibility to infection and pulmonary hypertension due to congenital heart disease in this patient may have led to the development of the pulmonary hemorrhage.[ncbi.nlm.nih.gov]
  • A 49-year-old man underwent pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension.[ncbi.nlm.nih.gov]
Palpable Purpura
  • Associated clinical features included fever, fatigue, palpable purpura, polyarthritis, and nephritis. Positive findings on chest radiography prompted the bronchoalveolar lavage procedure, which led to the identification of pulmonary hemorrhage.[ncbi.nlm.nih.gov]

Workup

  • Pulmonary infections are rarely reported in association with DAH, but they should be considered in the diagnostic workup because of the obvious therapeutic implications.[link.springer.com]
Pulmonary Infiltrate
  • Respiratory symptoms and pulmonary infiltrates on chest X-ray were absent upon admission.[ncbi.nlm.nih.gov]
  • Criterion C: Diffuse, bilateral pulmonary infiltrates on Chest X-ray (CXR) or Computerized Tomography (CT) of the chest.[cdc.gov]
  • A chest roentgenogram showed a recurrence of diffuse, hazy, bilateral pulmonary infiltrates that were similar to those seen earlier.[nejm.org]
  • The chest x-ray (Figure) showed bilateral pulmonary infiltrates of recent onset and fibrobronchoscopy showed an absence of endobronchial lesions; hemoglobin had decreased by 5 g/dL.[revespcardiol.org]
  • Chest radiographs showed bilateral pulmonary infiltrates occupying all four quadrants, confirmed by chest CT, on the day of admission (Figure 1 ). Figure 1 Chest X-ray and CT scan. (A) Chest X-ray where bilateral pulmonary infiltrates were observed.[jintensivecare.biomedcentral.com]
Bilateral Pulmonary Infiltrate
  • Criterion C: Diffuse, bilateral pulmonary infiltrates on Chest X-ray (CXR) or Computerized Tomography (CT) of the chest.[cdc.gov]
  • The chest x-ray (Figure) showed bilateral pulmonary infiltrates of recent onset and fibrobronchoscopy showed an absence of endobronchial lesions; hemoglobin had decreased by 5 g/dL.[revespcardiol.org]
  • A chest roentgenogram showed a recurrence of diffuse, hazy, bilateral pulmonary infiltrates that were similar to those seen earlier.[nejm.org]
  • Chest radiographs showed bilateral pulmonary infiltrates occupying all four quadrants, confirmed by chest CT, on the day of admission (Figure 1 ). Figure 1 Chest X-ray and CT scan. (A) Chest X-ray where bilateral pulmonary infiltrates were observed.[jintensivecare.biomedcentral.com]

Treatment

  • Rituximab may be a useful therapeutic option for the treatment of refractory PH.[ncbi.nlm.nih.gov]
  • All of the cases survived after treatment for concurrent VTE and PH, and received short- or long-term anticoagulation treatment after discharge.[ncbi.nlm.nih.gov]
  • Early treatment with steroid pulse therapy combined with plasma exchange resolved the patient's pulmonary hemorrhage and renal dysfunction.[ncbi.nlm.nih.gov]
  • Plasma exchange may be considered for treatment of pulmonary renal syndrome or refractory pulmonary hemorrhage.[ncbi.nlm.nih.gov]
  • Mortality risk was significantly lower in the treatment group (RR 0.52; 95%CI 0.31, 0.89, p[ncbi.nlm.nih.gov]

Prognosis

  • As a cutaneous variant of lupus erythematosus, discoid lupus erythematosus (DLE) is thought to have a good prognosis; however, the involvement of internal organs with a transition to systemic disease may occur.[ncbi.nlm.nih.gov]
  • For a good prognosis, it is necessary to start treatment immediately in patients with anti-GBM antibody-positive SLE associated with pulmonary hemorrhage.[ncbi.nlm.nih.gov]
  • Studies Gestational Age Hemoptysis/epidemiology Hemoptysis/etiology* Humans Infant, Newborn Infant, Premature* Infant, Premature, Diseases/epidemiology Infant, Premature, Diseases/etiology* Infant, Very Low Birth Weight* Male Pennsylvania/epidemiology Prognosis[ncbi.nlm.nih.gov]
  • Patients with the cryoglobulinemic pulmonary hemorrhage have an extremely poor prognosis and high mortality at presentation and even a poorer prognosis in survivors having further hemorrhagic episodes [ 1 ].[academic.oup.com]
  • The management and prognosis of idiopathic pulmonary hemosiderosis, based on cumulative experience from published reports, are considered in more detail. Copyright 2004 Wiley-Liss, Inc.[ncbi.nlm.nih.gov]

Etiology

  • Considered as a possible etiology, MMF was withdrawn. There was immediate improvement of the patient's symptoms.[ncbi.nlm.nih.gov]
  • * Humans Infant, Newborn Infant, Premature* Infant, Premature, Diseases/epidemiology Infant, Premature, Diseases/etiology* Infant, Very Low Birth Weight* Male Pennsylvania/epidemiology Prognosis Retrospective Studies Survival Rate/trends[ncbi.nlm.nih.gov]
  • Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown etiology with multisystem involvement.[ncbi.nlm.nih.gov]
  • This review article explores the imaging findings in DPH and its differential diagnosis, highlighting important clues to this diagnosis and to its underlying etiology.[ncbi.nlm.nih.gov]
  • We speculate that an adulterating agent may be the underlying etiology in these cases.[ncbi.nlm.nih.gov]

Epidemiology

  • […] etiology* Humans Infant, Newborn Infant, Premature* Infant, Premature, Diseases/epidemiology Infant, Premature, Diseases/etiology* Infant, Very Low Birth Weight* Male Pennsylvania/epidemiology Prognosis Retrospective Studies Survival Rate/trends[ncbi.nlm.nih.gov]
  • […] hemorrhage has been reported to precede DPO in some cases Hemoptysis (see Hemoptysis, [[Hemoptysis]]) Epidemiology : xxx Interstitial Pulmonary Fibrosis (see Interstitial Lung Disease, [[Interstitial Lung Disease]]) Epidemiology : occurs with recurrent[mdnxs.com]
  • London Health Protection Agency (HPA) (2009) Pandemic (H1N1) 2009 in England: an overview of initial epidemiological findings and implications for the second wave. Available at . Accessed 27 February 2012 26.[link.springer.com]
Sex distribution
Age distribution

Pathophysiology

  • The specific pathophysiology and manifestations vary depending on cause.[merckmanuals.com]
  • Negative-pressure pulmonary edema is the result of three pathophysiologic processes: negative intrathoracic pressure, 6 increase of systemic vascular and pulmonary capillary hydrostatic pressure, and mechanical stress at the alveolar–capillary level.[anesthesiology.pubs.asahq.org]
  • On rare occasions pheochromocytoma can present with atypical manifestations such as hemoptysis, acute coronary syndrome with normal coronary catheterization or dilated cardiomyopathy. 1 Pathophysiological mechanisms most often involved in hemoptysis are[archbronconeumol.org]
  • It is imperative to understand this pathophysiology as many clinical findings are nonspecific and thus, the diagnosis may be difficult to ascertain. (2,7) DAH is characterized by 3 distinct histological types: Pulmonary Capillaritis, Bland Damage, and[emdocs.net]
  • Dolhnikoff M, Mauad T, Bethlem EP, Carvalho CR (2007) Pathology and pathophysiology of pulmonary manifestations in leptospirosis. Braz J Infect Dis 11:142–148 PubMed CrossRef Google Scholar 53.[link.springer.com]

Prevention

  • Proper prenatal care and preventing premature labor and delivery were the most important preventative factors. A quick, deep thrust of intratracheal epinephrine with a catheter may improve survival. 2012 The Authors.[ncbi.nlm.nih.gov]
  • When this happens, blood leaks into the airways, preventing adequate breathing. Pulmonary hemorrhage can occur with systemic lupus, Goodpasture’s syndrome and Wegener’s granulomatosis.[web.archive.org]
  • Intensive supportive care prevented a fatal outcome.[ncbi.nlm.nih.gov]
  • Prospective studies are needed to evaluate the efficacy, reliability, and long-term results of rFVIIa in the prevention and treatment of pulmonary hemorrhage in premature infants.[ncbi.nlm.nih.gov]
  • Management of this complication is mainly preventive through adequate patient selection for ablation therapy and exclusion of technically avoidable risk factors.[ncbi.nlm.nih.gov]

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