Pneumonia
Charles Theisler in Adjuvant Medical Care, 2022
Pneumonia is an acute inflammation of the lung parenchyma (alveoli, alveolar ducts, and bronchioles) that can cause mild to severe illness in people of all ages. Most often an infection inflames lung tissue and the small air sacs, or alveoli, inside the lungs which fill up with fluid and/or purulent material (pus) reducing oxygen intake. Pneumonia is a major public health problem in the elderly in general and especially in nursing home (NH) residents. It is also the leading infectious cause of death in children less than five years old. 1 Symptoms, which can vary from mild to serious, can include productive cough, fever, chills, chest pain, hemoptysis, and difficulty breathing. Complications include lung abscesses, ARDS, pleural effusions, empyema, and pleurisy. Overwhelming sepsis is potentially a lethal complication.
Small Cell Lung Carcinoma
Dongyou Liu in Tumors and Cancers, 2017
Small cell lung carcinoma (SCLC) is a malignant epithelial tumor characterized by the presence of round, oval, and spindle-shaped small cells with scant cytoplasm, extensive necrosis, high mitotic figures, and neuroendocrine morphology. Risk factors for lung cancer including SCLC are tobacco smoking, air pollution, radon gas, uranium, radiation, asbestos, nickel, and chromium exposure. The pathogenesis of SCLC may be related to the neuroendocrine activity and autoimmune phenomena. Clinical symptoms of lung cancer range from coughing, dyspnea, hemoptysis, respiratory tract infections, chest pain, loss of appetite, weight loss, to fatigue. Diagnosis of lung cancer involves medical history review, clinical examination, imaging, bronchoscopy with biopsy, cytological and histological examination of fine-needle aspirate or biopsy specimen. Treatment for lung cancer includes surgery, radiation therapy, or chemotherapy, either alone or in different combinations. For recurrent SCLC, treatment options include chemotherapy and palliative therapy.
Hemoptysis
Sujal Desai, Tomas Franquet, Thomas E. Hartman, Athol Wells in Pulmonary Imaging, 2007
Chest radiography is the initial imaging test used in the evaluation of a patient with hemoptysis. Chest radiography may sometimes reveal the location and the underlying cause of hemoptysis, e.g. lung cancer (Figure 14.1). Other diagnostic findings may include lung abscess, mycetoma, arteriovenous malformation, broncholithiasis, etc. Patchy alveolar infiltrates seen bilaterally may indicate diffuse pulmonary alveolar hemorrhage, as seen in Goodpasture’s syndrome or pulmonary vasculitides (Figure 14.2). However, chest radiography may only reveal non-specific findings or no relevant abnormalities in 20-40% of patients with hemoptysis.1 It may also show abnormalities in areas other than the actual site of bleeding and potentially mislead the clinician. For example, blood from an upper lobe lesion may extend to the lower lung, resulting in areas of parenchymal opacification in the lower lungs. The radiograph can also be used to help target bronchoscopy. However, the diagnostic yield of fiberoptic bronchoscopy for patients with hemoptysis and a normal or non-localizing chest radiograph is only 10-20%.
Hemoptysis with diagnostic dilemma
Published in Expert Review of Respiratory Medicine, 2013
Hemoptysis is a common symptom. Although initial diagnostic workup, including a chest radiograph, often gives a clue to the cause, it provides no diagnostic hints in 3.0–42.2% of episodes of hemoptysis. To describe those cases with no diagnostic hints at initial investigations, experts have used different terms, including unexplained hemoptysis, idiopathic hemoptysis, cryptogenic hemoptysis and hemoptysis with normal chest radiographs. As hemoptysis is a common symptom of bronchogenic carcinoma, there is a concern of having underlying malignancy. Physicians value high-resolution computed tomography and fiberoptic bronchoscopy as the next investigations to establish diagnosis. These investigations however are expensive and nonspecific results are common in those cases of hemoptysis where initial diagnostic workup gives no clues to the cause. As a result, controversies exist with regard to their use. In this article, the author has proposed diagnostic approaches to evaluate those cases of hemoptysis with no diagnostic hints at initial investigation, after extensive review of published articles related to the case scenario.
Transcatheter Arterial Embolization for Massive Hemoptysis in Patients with Coal Workers' Pneumoconiosis: An 11-Year Experience
Published in Acta Radiologica, 2008
Sang Hoon Lee, Seong Tai Hahn, Byung Gil Choi
Background: Transcatheter arterial embolization (TAE) is a safe and well-established treatment option to control hemoptysis, but there are few studies focused on treating hemoptysis accompanying coal workers' pneumoconiosis (CWP). Purpose: To evaluate the immediate and long-term efficacy of TAE for control of massive hemoptysis in patients with CWP, and to clarify the factors which influence the frequency of rebleeding. Material and Methods: This study included 34 CWP patients with massive hemoptysis who were treated with 47 TAE sessions over the last 11 years. Immediate (within 1 month) and long-term outcomes (mean 37 months, range 1 month–11 years) were evaluated retrospectively. The relationships between the frequency of rebleeding and the type of CWP, angiographic findings, and presence of tuberculosis were evaluated. Results: The immediate success rate was 91.2% (31/34). In 23 patients (68%), hemoptysis did not recur on long-term follow-up. In eight patients who received repeated procedures for recurrent hemoptysis, bleeding was discovered in the non-bronchial systemic artery (n = 13) or bronchial artery (n = 7). The frequency of recurrent hemoptysis was higher in cases with complicated pneumoconiosis (n = 7) than in cases of the simple type (n = 1; P = 0.029). There was no statistical difference between rebleeding and angiographic findings or the presence of tuberculosis. Conclusion: TAE is an effective treatment modality for controlling massive hemoptysis in patients with CWP. However, many non-bronchial systemic collaterals contribute to recurrent hemoptysis. Furthermore, there is a high probability of rebleeding in patients with the complicated type of CWP, and extra care must be taken in the embolization procedure.
Angiosarcoma of the Right Atrium Presenting as Hemoptysis
Published in Baylor University Medical Center Proceedings, 2016
Charles H. Choi, Subbareddy Konda, Jay G. Shake
This case report describes a previously healthy 32-year-old man who presented with several weeks of hemoptysis. Initially he was treated with antibiotics with a preliminary diagnosis of pneumonia. With increasing hemoptysis and additional symptoms, he was referred to our institution. Cardiac magnetic resonance imaging suggested a diagnosis of right atrial angiosarcoma with extensive pulmonary metastases. His extensive pulmonary tumor burden caused the hemoptysis. Pulmonary biopsy was well tolerated, and he was referred to medical oncology for adjuvant therapy. Following the first cycle of chemotherapy, his hemoptysis lessened.