Clinical Diagnosis of Pulmonary Hemorrhage
Philip T. Cagle, Timothy C. Allen, Mary Beth Beasley in Diagnostic Pulmonary Pathology, 2008
Diffuse alveolar hemorrhage is an uncommon condition with protean causes. The clinical presentation can range from acute and life-threatening hemorrhage, which may or may not be associated with obvious hemoptysis, to a much more chronic and indolent condition characterized by dyspnea and anemia. Furthermore, the pulmonary disease may or may not be associated with disease in other organ systems. The diagnosis is therefore sometimes inapparent and has many masquerades. Pulmonary hemorrhage may be clinically manifested in three predominant clinical patterns: Massive alveolar hemorrhage sometimes with substantial hemoptysisRecurrent hemorrhage and usually hemoptysis with pulmonary infiltratesProgressive dyspnea and pulmonary infiltrates and anemia that may be associated with hemoptysis
Radiology of Infectious Diseases and Their Potential Mimics in the Critical Care Unit
Cheston B. Cunha, Burke A. Cunha in Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Pulmonary hemorrhage may result from trauma, bleeding diathesis, infection, and autoimmune causes. It is also the most common non-infectious pulmonary complication of acute leukemia, in which case hemoptysis is uncommon. Radiographic findings include bilateral coalescent air-space opacities, which develop rapidly and commonly improve rapidly with a time course of hours, as opposed to days or weeks, such as with most patients with pneumonia [77,94].
Bronchoscopy for specific situations
Don Hayes, Kara D. Meister in Pediatric Bronchoscopy for Clinicians, 2023
Many disease processes may lead to pulmonary hemorrhage. These include a myriad of diseases leading to diffuse alveolar hemorrhage syndrome (DAH), including infectious, malignant, and inflammatory etiologies. This section will focus only on bronchoscopic intervention associated with large-volume pulmonary hemorrhage or central airway bleeding events.
Diffuse alveolar haemorrhage in a case with anti-RNA polymerase III antibody-positive systemic sclerosis successfully treated with plasma exchange and corticosteroid therapy
Published in Modern Rheumatology Case Reports, 2020
Akimasa Asai, Shogo Banno, Nao Asai, Mayumi Ito, Hirokazu Sugiyama, Makoto Yamaguchi, Shiho Iwagaitsu, Hironobu Nobata, Hiroshi Kinasi, Takayuki Katsuno, Yasuhiko Ito
Bronchoscopy was immediately conducted, and serially collected bronchoalveolar lavage (BAL) aliquots showed increasing amounts of blood. However, hemosiderin-laden macrophages were not detected in BAL fluid. Pulmonary haemorrhage was demonstrated. Bacterial or fungal culture of BAL fluid demonstrated normal flora. Based on these findings, the patient was diagnosed as having diffuse alveolar haemorrhage with early-phase SSc. Anti-RNAP III antibody at admission was elevated, at 1340 enzyme-linked immunosorbent assay (ELISA) index (negative reference value < 28), but anti-Scl-70 and anti-centromere antibodies were negative. Possible underlying disorders including ANCA-associated vasculitis, anti-glomerular basement membrane (GBM) disease or SLE were speculated. However, myeloperoxidase (MPO)-ANCA, proteinase3 (PR3)-ANCA, anti-GBM, anti-dsDNA, anti-cardiolipin (CL) and anti-CL.β2-glycoprotein I complex antibodies were not detected (Table 1). Intravenous methyl-prednisolone 1.0 g/day (m-PSL pulse) was administered for diffuse alveolar haemorrhage for three consecutive days after admission (Figure 2); however, her chest-X ray showed progression of ground-glass opacity. Her respiratory condition gradually worsened and oxygenation was exacerbated despite high-flow nasal oxygenation of 40 L. Finally, she failed to respiratory failure.
Concurrent pulmonary artery aneurysms and intracardiac thrombus in a Caucasian man with Behçet’s disease: case report and literature review
Published in Modern Rheumatology Case Reports, 2018
Jean Liew, Daniela Ghetie, Danielle Hosmer, Cailin Sibley
(A) CTA of the thorax on initial presentation (May 2014). There are multiple bilateral pulmonary artery aneurysms. The dominant/sentinel aneurysms are in the left upper lobe (top left), and bilateral lower lobes (top right and bottom left). There is a small amount of nodular ground glass opacification around the left upper lobe aneurysm, likely representing minimal haemorrhage. (B) CTA of the thorax 3.5 months later (August 2014). The size of left upper lobe aneurysm has decreased, and the associated mural thrombus has increased. The size of the dominant right lower lobe aneurysm has decreased as well. However, there are new areas of nodular ground glass opacification throughout the right lung, consistent with pulmonary haemorrhage. (C) CTA of the thorax 5.5 months after initial presentation (December 2014). The prior areas of pulmonary haemorrhage have resolved. The left upper lobe has scarred down and has a stable appearance. The left lower lobe aneurysm has mildly decreased in size and the associate mural thrombus has increased.
Management of incidental pulmonary nodules: current strategies and future perspectives
Published in Expert Review of Respiratory Medicine, 2020
Tae Jung Kim, Cho Hee Kim, Ho Yun Lee, Myung Jin Chung, Sun Hye Shin, Kyung Jong Lee, Kyung Soo Lee
The most common complication of TTNB is pneumothorax, with a reported incidence of 8–30% [110]. Smaller target nodule size, the presence of emphysema, needle with larger bore, deeply-located lesions, and traversing a fissure are the known risk factors for pneumothorax. Pulmonary hemorrhage is the second most common complication, with a reported incidence of 4–27% [111]. Risk factors for hemoptysis include the target size (more in small nodules), nodule density (more in ground-glass nodules), presence of open bronchus within target lesion, and depth of target lesions. CT-guided biopsy is currently the most popular guiding modality. The recently introduced cone-beam CT-guided virtual navigation biopsy system, which provides real-time capability and CT fusion, has also been shown to be accurate and safe [112].
Related Knowledge Centers
- Bleeding
- Respiratory Tract
- Trachea
- Lung
- Cyanosis
- Blood
- Acute
- Pulmonary Alveolus
- Hemoptysis
- Modes of Mechanical Ventilation