1
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Devkota S, Bhujade H, Baloji A, Prabhakar N, Saroch A, Gorsi U. Successful Endovascular Management of Recurrent Hemoptysis due to Multiple Rasmussen Aneurysms in a Case of Pulmonary Tuberculosis: A Rare Case Scenario. Acta Med Litu 2024; 31:194-199. [PMID: 38978872 PMCID: PMC11227676 DOI: 10.15388/amed.2024.31.1.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/25/2024] [Accepted: 05/29/2024] [Indexed: 07/10/2024] Open
Abstract
Background Hemoptysis is defined as coughing out of blood. Pulmonary tuberculosis is the most common cause of hemoptysis in tuberculosis-endemic countries like India. Rasmussen aneurysm is a pseudoaneurysm arising from the pulmonary artery adjacent to or within a tuberculous cavity. Chest radiographs, chest computed tomography angiography (CTA), and digital subtraction angiography (DSA) are the imaging tools for evaluating a case of hemoptysis. Case A 32-year-old man with a history of pulmonary tuberculosis presented with complaints of recurrent hemoptysis. On imaging evaluation, multiple pulmonary artery pseudoaneurysms were seen in the left lung. The patient was shifted to the DSA lab and the pseudoaneurysms were subsequently treated by endovascular coil embolization. Hemoptysis resolved following the procedure and the patient was again started on anti-tubercular therapy. Conclusion Endovascular coiling is minimally invasive, safe, and effective management of multiple Rasmussen aneurysms for preventing possible torrential blood loss and unfortunate death.
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Affiliation(s)
- Shritik Devkota
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Abhiman Baloji
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Nidhi Prabhakar
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Atul Saroch
- Department of Internal Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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2
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Nimal S, Palaniswamy G, Pillikunte Doddareddy N, Talacheru S, Jadhav S, Mareedu T, Parmar MP, Banur A. Hemoptysis Secondary to Anomalous Origin of Right Pulmonary Artery From Ascending Aorta in a Young Male: A Case Report. Cureus 2024; 16:e51634. [PMID: 38313938 PMCID: PMC10837743 DOI: 10.7759/cureus.51634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
We report a rare case of a 24-year-old male with a rare anatomic variant of patent ductus arteriosus (PDA). The patient presented with symptoms of productive cough with recurrent and severe bouts of hemoptysis and grade I dyspnea. There were no prior episodes reported. The patient was vitally stable with bilateral clubbing. On cardiopulmonary auscultation, a prominent parasternal heave, loud P2, and right lung crepitus were noted. A complete blood count revealed an elevated hemoglobin and RBC count. An ECG revealed sinus tachycardia and right ventricle (RV) strain. ECHO confirmed these findings, as dilated right atrium (RA) and RV, mild tricuspid valve regurgitation (TR), and severe pulmonary hypertension were noted. CT of the chest demonstrated multiple ground glass opacities, right lung consolidation, and volume loss suggestive of right-sided pneumonia with atelectasis. CT also proved the presence of PDA and an anomalous origin of the right pulmonary artery from the right ascending aorta, causing compression of the right main bronchus. We show the clinical and radiological findings and discuss the implications and approach to this rare congenital cardiovascular malformation, as well as how a patient-centered approach is necessary for its management.
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Affiliation(s)
- Simran Nimal
- Internal Medicine, Byramjee Jeejeebhoy Government Medical College, Pune, IND
| | | | | | - Sahithi Talacheru
- Internal Medicine, MediCiti Institute of Medical Sciences, Hyderabad, IND
| | - Shraddha Jadhav
- Internal Medicine, Teaching University Geomedi, Tbilisi, GEO
| | - Tanmayee Mareedu
- Internal Medicine, Mamata Academy of Medical Sciences, Hyderabad, IND
| | - Mihirkumar P Parmar
- Internal Medicine, Gujarat Medical Education and Research Society, Vadodara, IND
| | - Anup Banur
- Pulmonology, S. S. Institute of Medical Sciences and Research Centre, Davanagere, IND
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3
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Huang J, Zeng Q, Wei C, Dai Y. Fiberoptic bronchoscopy combined with urokinase therapy for the treatment of fatal massive hemoptysis: A case report. Medicine (Baltimore) 2023; 102:e36131. [PMID: 37986294 PMCID: PMC10659648 DOI: 10.1097/md.0000000000036131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Fatal massive hemoptysis is a life-threatening emergency in the respiratory system. Currently, the treatment methods and techniques for massive hemoptysis are still limited, and there are often issues of delayed treatment or improper methods in clinical practice, leading to the difficulty of rescuing patients and high mortality rates. When fatal massive hemoptysis occurs, the key to successful treatment lies in whether intrapulmonary blood clots can be effectively cleared and airway patency can be ensured. Our practice of combining fiberoptic bronchoscopy with urokinase treatment to clear intrapulmonary blood clots after fatal massive hemoptysis demonstrates the effectiveness of this method. CASE SUMMARY We report a 32-year-old female who experienced cough, accompanied by fatal massive hemoptysis with extensive blood clot obstruction in the airway. Considering the difficulty of clearing the airway using conventional methods, it was decided to perform fiberoptic bronchoscopy combined with urokinase therapy after reviewing relevant literature. After treatment, the intrapulmonary blood clots were successfully extracted, thereby relieving airway obstruction. Finally, the patient was successfully weaned off extracorporeal membrane oxygenation, extubated, and evacuated from the ventilator. Currently, the patient's condition is stable, and follow-up chest X-ray as well as computed tomography scans have shown improvement compared to previous assessments. CONCLUSION Fatal massive hemoptysis is a intractable emergency in clinical practice. In this case, we confirmed that fiberoptic bronchoscopy combined with urokinase therapy may be effective and safe in the treatment of fatal massive hemoptysis.
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Affiliation(s)
- Ju Huang
- The Department of Respiratory and Critical Care Medicine, Affiliated Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, Guangdong, China
| | - Qigang Zeng
- The Department of Respiratory and Critical Care Medicine, Affiliated Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, Guangdong, China
| | - Chengong Wei
- The Department of Respiratory and Critical Care Medicine, Affiliated Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, Guangdong, China
| | - Yong Dai
- The Department of Respiratory and Critical Care Medicine, Affiliated Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, Guangdong, China
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4
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Singer ED, Faiz SA, Qdaisat A, Abdeldaem K, Dagher J, Chaftari P, Yeung SCJ. Hemoptysis in Cancer Patients. Cancers (Basel) 2023; 15:4765. [PMID: 37835458 PMCID: PMC10571539 DOI: 10.3390/cancers15194765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
Hemoptysis in cancer patients can occur for various reasons, including infections, tumors, blood vessel abnormalities and inflammatory conditions. The degree of hemoptysis is commonly classified according to the quantity of blood expelled. However, volume-based definitions may not accurately reflect the clinical impact of bleeding. This review explores a more comprehensive approach to evaluating hemoptysis by considering its risk factors, epidemiology and clinical consequences. In particular, this review provides insight into the risk factors, identifies mortality rates associated with hemoptysis in cancer patients and highlights the need for developing a mortality prediction score specific for cancer patients. The use of hemoptysis-related variables may help stratify patients into risk categories; optimize the control of bleeding with critical care; implement the use of tracheobronchial or vascular interventions; and aid in treatment planning. Effective management of hemoptysis in cancer patients must address the underlying cause while also providing supportive care to improve patients' quality of life.
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Affiliation(s)
- Emad D. Singer
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (E.D.S.); (A.Q.); (K.A.)
- Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Saadia A. Faiz
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Aiham Qdaisat
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (E.D.S.); (A.Q.); (K.A.)
| | - Karim Abdeldaem
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (E.D.S.); (A.Q.); (K.A.)
| | - Jim Dagher
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut 1100, Lebanon
| | - Patrick Chaftari
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (E.D.S.); (A.Q.); (K.A.)
| | - Sai-Ching J. Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (E.D.S.); (A.Q.); (K.A.)
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5
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Benjamin SR, Nair AA, Joel RK, Gnanamuthu BR, Rao VM, Andugala SS. An overview on the principles of management of haemoptysis. Indian J Thorac Cardiovasc Surg 2023; 39:505-515. [PMID: 37609603 PMCID: PMC10442015 DOI: 10.1007/s12055-023-01547-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/19/2023] [Accepted: 05/24/2023] [Indexed: 08/24/2023] Open
Abstract
Haemoptysis is a frequently encountered presentation in thoracic surgery practice. Most of the patients present with chronic haemoptysis while 5% of them will present with life-threatening acute haemoptysis. Emergency surgery used to be the first-line management in acute life-threatening haemoptysis which resulted in significant morbidity and mortality. With advancements in interventional procedures, most of these acute presentations are now being managed conservatively by interventionists. In a country like India with a high incidence of tuberculosis and other infectious diseases of the lungs, haemoptysis is even more common. While interventional procedures help to tide over the crisis and earn valuable time to stabilise a haemorrhaging patient, surgical resection is the definitive management most of the time. This review will endeavour to establish the definition, aetiology, emergency, and definitive management of a patient who presents with haemoptysis.
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Affiliation(s)
- Santhosh Regini Benjamin
- Department of Cardiothoracic Surgery, The Christian Medical College (CMC Hospital), Vellore, 632004 Tamil Nadu India
| | - Avinash Anil Nair
- Department of Respiratory Medicine, The Christian Medical College, Vellore, 632004 Tamil Nadu India
| | - Raj Kumar Joel
- Department of Cardiothoracic Surgery, The Christian Medical College (CMC Hospital), Vellore, 632004 Tamil Nadu India
| | - Birla Roy Gnanamuthu
- Department of Cardiothoracic Surgery, The Christian Medical College (CMC Hospital), Vellore, 632004 Tamil Nadu India
| | - Vinay Murahari Rao
- Department of Cardiothoracic Surgery, The Christian Medical College (CMC Hospital), Vellore, 632004 Tamil Nadu India
| | - Shalom Sylvester Andugala
- Department of Cardiothoracic Surgery, The Christian Medical College (CMC Hospital), Vellore, 632004 Tamil Nadu India
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6
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Kaya AG, Öz M, Dilegelen U, Ecer D, Erol S, Çiftçi F, Çiledağ A, Kaya A. IS FLEXIBLE BRONCHOSCOPY A SAFE PROCEDURE FOR CRITICAL CARE PATIENTS WITH RESPIRATORY FAILURE? Acta Clin Croat 2023; 62:291-299. [PMID: 38549601 PMCID: PMC10969639 DOI: 10.20471/acc.2023.62.02.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/30/2021] [Indexed: 04/02/2024] Open
Abstract
Flexible bronchoscopy (FB) plays an important role in critical care patients. But, critical care patients with respiratory failure are at an increased risk of developing complications. Considering the developments in intensive care unit care in recent years, we aimed to evaluate the use of FB in these patients. We retrospectively reviewed patients who underwent FB in critical care between 2014 and 2020. A total of 143 patients underwent FB during the study period. Arterial blood gas measurement on the FB day revealed a mean PaO2/FiO2 of 186.94±28.47. Eighty-one (56.6%) patients underwent an fiberoptic bronchoscopy procedure under conventional oxygen supplementation, 10 (7%) on noninvasive ventilation, 13 (9.1%) on high flow nasal cannula, and 39 (27.3%) on invasive mechanical ventilation. During and immediately after bronchoscopy, none of the patients experienced life-threatening complications. Fifty-five (38.5%) patients developed complications that could be controlled. Multivariate analysis indicated that increased Apache-II score and presence of cardiovascular disease were significantly associated with an increased complication risk. Although critical care patients with respiratory failure are more prone to complications, diagnostic and therapeutic bronchoscopy may be performed following appropriate patient selection, without leading to major complications.
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Affiliation(s)
- Aslıhan Gürün Kaya
- Ankara University, Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
| | - Miraç Öz
- Ankara University, Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
| | - Umut Dilegelen
- Ankara University, Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
| | - Duygu Ecer
- Ankara University, Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
| | - Serhat Erol
- Ankara University, Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
| | - Fatma Çiftçi
- Ankara University, Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
| | - Aydın Çiledağ
- Ankara University, Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
| | - Akın Kaya
- Ankara University, Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
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7
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Marak JR, Kumar T, Gara H, Dwivedi S. Rasmussen aneurysm: Case series of a rare complication of Pulmonary Tuberculosis. Respir Med Case Rep 2023; 45:101897. [PMID: 37577119 PMCID: PMC10413191 DOI: 10.1016/j.rmcr.2023.101897] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/15/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023] Open
Abstract
Rasmussen aneurysm refers specifically to a pseudoaneursysmal dilatation of a branch of the pulmonary artery adjacent or within a tuberculous cavity. The incidence of pulmonary vascular complication secondary to tuberculosis is very rare hence underdiagnosed by many clinicians. It can present with life threatening haemoptysis and CT angiography plays an important role in localizing the lesion and guiding treatment. On contrary the most common cause of massive haemoptysis is of bronchial artery origin. Early diagnosis and proper interventions are essential as it is associated with high mortality. Herein we report three cases of Rasmussen aneurysm in patients with haemoptysis. Only one patient underwent emergency trans-arterial embolization of the involved pulmonary artery.
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Affiliation(s)
- James R. Marak
- Department of Radiodiagnosis, Dr RMLIMS, Gomti Nagar, Lucknow, Uttar Pradesh, 226010, India
| | - Tushant Kumar
- Department of Radiodiagnosis, Dr RMLIMS, Gomti Nagar, Lucknow, Uttar Pradesh, 226010, India
| | - Harsha Gara
- Department of Radiodiagnosis, Dr RMLIMS, Gomti Nagar, Lucknow, Uttar Pradesh, 226010, India
| | - Shivam Dwivedi
- Department of Radiodiagnosis, Dr RMLIMS, Gomti Nagar, Lucknow, Uttar Pradesh, 226010, India
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8
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Wayne MT, Valley TS, Arenberg DA, De Cardenas J, Prescott HC. Temporal Trends and Variation in Bronchoscopy Use for Acute Respiratory Failure in the United States. Chest 2023; 163:128-138. [PMID: 36007595 PMCID: PMC9859725 DOI: 10.1016/j.chest.2022.08.2210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/26/2022] [Accepted: 08/10/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND National data on bronchoscopy for the evaluation of acute respiratory failure are lacking, and the limited available data suggest wide variation in use. RESEARCH QUESTION How commonly is bronchoscopy performed among hospitalizations with acute respiratory failure? How has use changed over time and across hospitals? STUDY DESIGN AND METHODS This was an observational cohort study of adult hospitalizations (2012-2018) treated with invasive mechanical ventilation (IMV) using the National Inpatient Sample, which represents 97% of all hospitalizations in the United States. We measured the proportion of hospitalizations treated with IMV who underwent bronchoscopy and assessed trends in bronchoscopy use over time. Multilevel linear regression models were used to quantify hospital-level variation, adjusting for differences in patient and hospital characteristics. RESULTS We identified 6,101,070 IMV-treated hospitalizations (2012-2018), of whom 609,405 underwent bronchoscopy; among hospitalizations receiving bronchoscopy, mean age was 61 years, 41.8% were women, and in-hospital mortality was 30.8%. The percentage of IMV-treated hospitalizations receiving bronchoscopy increased from 9.5% (95% CI, 9.1%-9.9%) in 2012 to 10.8% (95% CI, 10.4%-11.2%) in 2018 (P < .001 for difference). In 2018, bronchoscopy use varied from 0% to 57.1% among 1,787 hospitals, and in multilevel models adjusted for patient and hospital characteristics, 16.0% of the variation was explained at the hospital level. The median OR was 2.13 (95% CI, 2.05-2.21), indicating 113% increased odds of receiving bronchoscopy if moving from a lower-use to a higher-use hospital. INTERPRETATION Bronchoscopy use among hospitalizations treated with IMV has increased over time. The large variation in use of bronchoscopy across hospitals suggests potentially unwarranted practice variation and need for further studies to clarify which patients benefit from bronchoscopy.
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Affiliation(s)
- Max T Wayne
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI.
| | - Thomas S Valley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
| | - Douglas A Arenberg
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI
| | - Jose De Cardenas
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI; Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Hallie C Prescott
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
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9
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Hümmler N, Elze M. Management von Hämoptysen: eine interdisziplinäre Herausforderung. Zentralbl Chir 2022; 147:S33-S46. [PMID: 36099935 DOI: 10.1055/a-1809-1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Nicolas Hümmler
- Klinik für Thoraxchirurgie, Department Chirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Mirjam Elze
- Klinik für Thoraxchirurgie, Department Chirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
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10
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Abstract
Massive hemoptysis is a highly morbid medical condition with up to 75% mortality with conservative treatment. Bronchial artery embolization has emerged as the common treatment for both acute massive hemoptysis and chronic hemoptysis. This article will review the clinical presentation, bronchial artery anatomy, embolization procedure, complications, and expected outcomes.
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Affiliation(s)
- Claire S. Kaufman
- Dotter Department of Interventional Radiology, Oregon Health & Sciences University, Portland, Oregon
| | - Sharon W. Kwan
- Dotter Department of Interventional Radiology, Oregon Health & Sciences University, Portland, Oregon
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11
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Wang D, Zhu J, Fan Y, Ma J, Yue S. Soft coagulation monopolar suction for rapid resection of supratentorial brain tumors: Feasibility of a new technique and outcomes. World Neurosurg 2022; 163:e137-e145. [DOI: 10.1016/j.wneu.2022.03.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
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12
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Haemoptysis in Pulmonary Arterial Hypertension Associated with Congenital Heart Disease: Insights on Pathophysiology, Diagnosis and Management. J Clin Med 2022; 11:jcm11030633. [PMID: 35160084 PMCID: PMC8836348 DOI: 10.3390/jcm11030633] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 12/12/2022] Open
Abstract
Haemoptysis represents one of the most severe major bleeding manifestations in the clinical course of pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD). Accumulating evidence indicates that dysfunction of the pulmonary vascular bed in the setting of PAH predisposes patients to increased hemorrhagic diathesis, resulting in mild to massive and life-threatening episodes of haemoptysis. Despite major advances in PAH targeted treatment strategies, haemoptysis is still correlated with substantial morbidity and impaired quality of life, requiring a multidisciplinary approach by adult CHD experts in tertiary centres. Technological innovations in the field of diagnostic and interventional radiology enabled the application of bronchial artery embolization (BAE), a valuable tool to efficiently control haemoptysis in modern clinical practice. However, bleeding recurrences are still prevalent, implying that the optimum management of haemoptysis and its implications remain obscure. Moreover, regarding the use of oral anticoagulation in patients with haemoptysis, current guidelines do not provide a clear therapeutic strategy due to the lack of evidence. This review aims to discuss the main pathophysiological mechanisms of haemoptysis in PAH-CHD, present the clinical spectrum and the available diagnostic tools, summarize current therapeutic challenges, and propose directions for future research in this group of patients.
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13
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Amin MA, Islam MT, Khan II, Khan ZH, Qadri F, Khan AI. COVID-19 and dengue infection in Bangladesh: A case of coinfection where hemoptysis as first presentation. Clin Case Rep 2022; 10:e05252. [PMID: 35079386 PMCID: PMC8777161 DOI: 10.1002/ccr3.5252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/05/2021] [Accepted: 12/09/2021] [Indexed: 11/08/2022] Open
Abstract
Bangladesh recently faced large outbreaks of both COVID-19 and dengue. We present a case of COVID-19 and dengue coinfection in a patient who presented with hemoptysis. Our results demonstrate that COVID-19 and dengue fever are both public health issues in Bangladesh and other dengue-endemic nations and that they can coexist.
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Affiliation(s)
- Mohammad Ashraful Amin
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Md Taufiqul Islam
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
- School of Medical ScienceGriffith UniversityGold CoastQueenslandAustralia
| | - Ishtiakul Islam Khan
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Zahid Hasan Khan
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Firdausi Qadri
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Ashraful Islam Khan
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
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14
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Villena-Vargas J, Voza F, Mick S, Shostak E. Bronchial Hemorrhage Control Using Arista AH: A Novel Bronchoscopic Approach. J Bronchology Interv Pulmonol 2021; 28:e57-e59. [PMID: 34546194 DOI: 10.1097/lbr.0000000000000745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Francesca Voza
- DeWitt Daughtry Family Department of Surgery, University of Miami School of Medicine/Jackson Memorial Medical Center, Miami, FL
| | - Stephanie Mick
- Cardiothoracic Surgery at Weill Cornell Medical Center, New York, NY
| | - Eugene Shostak
- Cardiothoracic Surgery at Weill Cornell Medical Center, New York, NY
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15
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Charya AV, Holden VK, Pickering EM. Management of life-threatening hemoptysis in the ICU. J Thorac Dis 2021; 13:5139-5158. [PMID: 34527355 PMCID: PMC8411133 DOI: 10.21037/jtd-19-3991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/24/2020] [Indexed: 12/12/2022]
Abstract
Life-threatening hemoptysis is commonly encountered in the ICU and its management can be challenging even for experienced clinicians. Depending on the etiology and severity, one can tailor the treatment modality and therapeutic intervention(s). The grading of severity of hemoptysis varies greatly in the literature; however, unlike hemorrhage in other scenarios, small amounts of blood can significantly impair oxygenation and ventilation leading to cardiovascular collapse. Importantly, the initial evaluation and management should focus on airway and hemodynamic stabilization along with maintenance of oxygenation and ventilation. In this review, we discuss commonly encountered etiologies, vascular anatomy, diagnostic evaluation, and therapeutic interventions. We examine the evolving trends in etiologies of life-threating hemoptysis over the years. The role of flexible and rigid bronchoscopy as both a diagnostic and therapeutic modality is explored, as well as the use and indications of several bronchoscopic techniques, such as topical hemostatic agents, endobronchial tamponade, and tranexamic acid (TXA). In addition, we assess the use of multi-row detector computed tomography as the initial rapid diagnostic method of choice and its use in planning for definitive treatment. The efficacy and long-term results of bronchial artery embolization (BAE) are evaluated, as well as indications for surgical intervention. Furthermore, the importance of a multidisciplinary approach is emphasized. The necessary interplay between intensivists, consultative services, and radiologists is described in detail and an algorithmic management strategy incorporating the above is outlined. Given the complexity in management of life-threatening hemoptysis, this paper aims to summarize the available diagnostic and therapeutic methods and provide a standardized approach for the management of patients with this often difficult to treat condition.
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Affiliation(s)
- Ananth V Charya
- Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Van K Holden
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Edward M Pickering
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA
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16
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Abstract
OBJECTIVES Hemoptysis is uncommon in children, even among the critically ill, with a paucity of epidemiological data to inform clinical decision-making. We describe hemoptysis-associated ICU admissions, including those who were critically ill at hemoptysis onset or who became critically ill as a result of hemoptysis, and identify predictors of mortality. DESIGN Retrospective cohort study. Demographics, hemoptysis location, and management were collected. Pediatric Logistic Organ Dysfunction-2 score within 24 hours of hemoptysis described illness severity. Primary outcome was inhospital mortality. SETTING Quaternary pediatric referral center between July 1, 2010, and June 30, 2017. PATIENTS Medical/surgical (PICU), cardiac ICU, and term neonatal ICU admissions with hemoptysis during or within 24 hours of ICU admission. INTERVENTIONS No intervention. MEASUREMENTS AND MAIN RESULTS There were 326 hemoptysis-associated ICU admissions in 300 patients. Most common diagnoses were cardiac (46%), infection (15%), bronchiectasis (10%), and neoplasm (7%). Demographics, interventions, and outcomes differed by diagnostic category. Overall, 79 patients (26%) died inhospital and 109 (36%) had died during follow-up (survivor mean 2.8 ± 1.9 yr). Neoplasm, bronchiectasis, renal dysfunction, inhospital hemoptysis onset, and higher Pediatric Logistic Organ Dysfunction-2 score were independent risk factors for inhospital mortality (p < 0.02). Pharmacotherapy (32%), blood products (29%), computerized tomography angiography (26%), bronchoscopy (44%), and cardiac catheterization (36%) were common. Targeted surgical interventions were rare. Of survivors, 15% were discharged with new respiratory support. Of the deaths, 93 (85%) occurred within 12 months of admission. For patients surviving 12 months, 5-year survival was 87% (95% CI, 78-92) and mortality risk remained only for those with neoplasm (log-rank p = 0.001). CONCLUSIONS We observed high inhospital mortality from hemoptysis-associated ICU admissions. Mortality was independently associated with hemoptysis onset location, underlying diagnosis, and severity of critical illness at event. Additional mortality was observed in the 12-month posthospital discharge. Future directions include further characterization of this vulnerable population and management recommendations for life-threatening pediatric hemoptysis incorporating underlying disease pathophysiology.
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Atchinson PRA, Hatton CJ, Roginski MA, Backer ED, Long B, Lentz SA. The emergency department evaluation and management of massive hemoptysis. Am J Emerg Med 2021; 50:148-155. [PMID: 34365064 DOI: 10.1016/j.ajem.2021.07.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/09/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Massive hemoptysis is a life-threatening emergency that requires rapid evaluation and management. Recognition of this deadly condition, knowledge of the initial resuscitation and diagnostic evaluation, and communication with consultants capable of definitive management are key to successful treatment. OBJECTIVE The objective of this narrative review is to provide an evidence-based review on the management of massive hemoptysis for the emergency clinician. DISCUSSION Rapid diagnosis and management of life-threatening hemoptysis is key to patient survival. The majority of cases arise from the bronchial arterial system, which is under systemic blood pressure. Initial management includes patient and airway stabilization, reversal of coagulopathy, and identification of the source of bleeding using computed tomography angiogram. Bronchial artery embolization with interventional radiology has become the mainstay of treatment; however, unstable patients may require advanced bronchoscopic procedures to treat or temporize while additional information and treatment can be directed at the underlying pathology. CONCLUSION Massive hemoptysis is a life-threatening condition that emergency clinicians must be prepared to manage. Emergency clinicians should focus their management on immediate resuscitation, airway preservation often including intubation and isolation of the non-bleeding lung, and coordination of definitive management with available consultants including interventional radiology, interventional pulmonology, and thoracic surgery.
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Affiliation(s)
- Patricia Ruth A Atchinson
- Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Colman J Hatton
- Dartmouth-Hitchcock Medical Center, Section of Critical Care Medicine, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Matthew A Roginski
- Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Elliot D Backer
- Dartmouth-Hitchcock Medical Center, Section of Critical Care Medicine, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, United States of America
| | - Skyler A Lentz
- Division of Emergency Medicine and Pulmonary Disease and Critical Care Medicine, The University of Vermont Larner College of Medicine, Burlington, VT, United States of America.
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18
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Chetana Shanmukhappa S, Lokeshwaran S, Kumar K S, Doraiswamy P. "Peanut saves the day": an innovative solution to massive, cryptogenic haemoptysis-a case study. Respirol Case Rep 2021; 9:e00754. [PMID: 33976883 PMCID: PMC8103091 DOI: 10.1002/rcr2.754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 11/09/2022] Open
Abstract
Massive (or life-threatening) haemoptysis is a time-sensitive emergency encountered by a physician that requires an interdisciplinary, collaborative effort to arrest the bleeding in a prompt and timely manner. Placement of an endobronchial Watanabe spigot (EWS) to halt haemoptysis is a relatively recent technique finding its wide application in airway pathology, with the current extension of its use to bronchial bleeding. However, the lack of immediate access to EWS gives rise to the need to innovate with day-to-day materials used in routine surgical practice and available in resource-limited settings, which may serve the purpose of a spigot. In this report, we bring to light a case of life-threatening, cryptogenic haemoptysis that was managed by a novel technique of using peanut gauze as a spigot resulting in a successful endobronchial tamponade.
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Affiliation(s)
| | | | - Sunil Kumar K
- Department of PulmonologyAster CMI HospitalBengaluruIndia
| | - Prakash Doraiswamy
- Department of Anaesthesia and Critical CareAster CMI HospitalBengaluruIndia
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Lee HN, Park HS, Hyun D, Cho SK, Park KB, Shin SW, Soo Do Y. Combined therapy with bronchial artery embolization and tranexamic acid for hemoptysis. Acta Radiol 2021; 62:610-618. [PMID: 32551802 DOI: 10.1177/0284185120933984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND While most previous studies have viewed tranexamic acid as a bridging or temporary therapy, our preliminary study offers insights into the combined therapy of antifibrinolytic agent with endovascular treatment for hemoptysis. PURPOSE To investigate the feasibility and safety of combined therapy, to analyze factors affecting the outcomes of combined therapy, and to compare the effectiveness of combined therapy between groups with different etiologies. MATERIAL AND METHODS Between January 2011 and December 2014, 64 patients (33 men, mean age 64.6 years) underwent combined therapy for hemoptysis. The median follow-up time was 14.7 months (range 174-2435 days). Patients were divided into a tuberculosis group (GroupTB, n=37) and a non-tuberculosis group (Groupnon-TB, n=27). RESULTS Embolotherapy was technically successful in 62/64 (96.9%) cases. The immediate clinical success rate was 96.8% (60/62). The short-term and long-term recurrence rates were 12.9% (n=8) and 19.4% (n=12), respectively. The one-, two-, and four-year recurrence-free survival rates were 61%, 49%, and 32%, respectively. There was no significant survival difference between the two groups. Suboptimal embolization was a significant risk factor for immediate clinical failure (odds ratio 29.624, P = 0.023). Optimal embolization (hazard ratio [HR] 0.199, P = 0.023) and older age (HR 0.956, P = 0.013) were significantly associated with lower recurrence risk. CONCLUSION Combined therapy is an effective and safe treatment modality for hemoptysis of various etiologies, with potential benefits for short-term recurrence vis-a-vis current literature evidence. Suboptimal embolization was the most important modifiable risk factor for treatment failure and recurrence after combined therapy.
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Affiliation(s)
- Hyoung Nam Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan-si, Republic of Korea
| | - Hong Suk Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Ki Cho
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwang Bo Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Wook Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Soo Do
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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20
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Chen W, Yuan S, Shen J, Chen Y, Xiao Y. A Composite Hydrogel Based on Pectin/Cellulose via Chemical Cross-Linking for Hemorrhage. Front Bioeng Biotechnol 2021; 8:627351. [PMID: 33604331 PMCID: PMC7884616 DOI: 10.3389/fbioe.2020.627351] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/29/2020] [Indexed: 11/22/2022] Open
Abstract
Hydrogel-based material have been demonstrated promising potential for hemostasis. Herein, we prepared a composite hydrogel (CH-P 40%) by combining pectin and cellulose in ionic liquid. The superficial morphology of the CH-P 40% was explored by SEM; the internal chemical bonds, crystal form and thermal stability were determined via FTIR, XRD and thermogravimetric analysis, respectively. The biocompatibilities of the CH-P 40% hydrogel was evaluated by MTT, flow cytometry, and histological observation with H&E staining. Furthermore, the hemostatic effect was evaluated via the blood clotting index and mouse liver hemostatic model. The results showed that the CH-P 40% hydrogel exhibited a dense network structure and retained its chemical bonds, including the OH, CH, C=O, -CH2, CO, C1-H, and β-glycosidic bonds. Simultaneously, the hydrogel retained the Cellulose I and II crystal structure and favorable thermal stability. Moreover, the proliferation rates of CH-P 40%-treated cells increased (P > 0.05), and there were no pathological lesions in the mouse organs, which suggests favorable biocompatibility. The results showed less bleeding in the hydrogel-treated liver wound within 3 min. Overall, the pectin-cellulose hydrogel is stable and possesses favorable biocompatibility and hemostatic ability, further highlighting that the composite hydrogel has the potential to be rapid hemostatic biomedical material.
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Affiliation(s)
- Wancheng Chen
- Translational Medicine Center, Jiangmen Central Hospital, Jiangmen, China
| | - Sijie Yuan
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Jie Shen
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Yongsheng Chen
- Department of Food Science and Engineering, Jinan University, Guangzhou, China
| | - Yang Xiao
- Translational Medicine Center, Jiangmen Central Hospital, Jiangmen, China
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21
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Abid N, Loukil M, Mokni A, Badri I, Bouzaidi K, Ghrairi H. Outcomes of bronchial artery embolization for the management of hemoptysis. LA TUNISIE MEDICALE 2021; 99:264-268. [PMID: 33899197 PMCID: PMC8636964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Hemoptysis is an alarming symptom that requires immediate investigation and management. Bronchial artery embolization (BAE) is a minimally invasive procedure that has become the treatment of choice of recurrent and massive hemoptysis. AIM To assess the efficacy and safety of BAE for management of recurrent and/or massive hemoptysis. METHODS A retrospective analysis was carried out of the medical records of 46 patients who were hospitalized in our department of pneumology in Mohamed Taher Maamouri hospital for hemoptysis and who underwent bronchial arteriography (BA) for the purpose of transarterial embolization. RESULTS The most frequent causes of hemoptysis included idiopathic bronchiectasis (32.6%), pulmonary tumors (26%) and tuberculosis (8.6%) Embolization was successfully performed in 97.5% of cases. Immediate cessation of haemoptysis was achieved in 95%. Recurrence of haemoptysis was noted in 12% of cases. No major complication involving the vital or the functional prognosis, related to BAE was noted. Conclusions: Our study confirms the safety and the efficacy of the BAE for management of massive and/or recurrent hemoptysis.
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22
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Ghiani A, Neurohr C. Diagnostic yield, safety, and impact of transbronchial lung biopsy in mechanically ventilated, critically ill patients: a retrospective study. BMC Pulm Med 2021; 21:15. [PMID: 33413299 PMCID: PMC7788549 DOI: 10.1186/s12890-020-01357-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022] Open
Abstract
Background Pulmonary infiltrates of variable etiology are one of the main reasons for hypoxemic respiratory failure leading to invasive mechanical ventilation. If pulmonary infiltrates remain unexplained or progress despite treatment, the histopathological result of a lung biopsy could have significant impact on change in therapy. Surgical lung biopsy is the commonly used technique, but due to its considerable morbidity and mortality, less invasive bronchoscopic transbronchial lung biopsy (TBLB) may be a valuable alternative. Methods Retrospective, monocentric, observational study in mechanically ventilated, critically ill patients, subjected to TBLB due to unexplained pulmonary infiltrates in the period January 2014 to July 2019. Patients’ medical records were reviewed to obtain data on baseline clinical characteristics, modality and adverse events (AE) of the TBLB, and impact of the histopathological results on treatment decisions. A multivariable binary logistic regression analysis was performed to identify predictors of AE and hospital mortality, and survival curves were generated using the Kaplan-Meier method. Results Forty-two patients with in total 42 TBLB procedures after a median of 12 days of mechanical ventilation were analyzed, of which 16.7% were immunosuppressed, but there was no patient with prior lung transplantation. Diagnostic yield of TBLB was 88.1%, with AE occurring in 11.9% (most common pneumothorax and minor bleeding). 92.9% of the procedures were performed as a forceps biopsy, with organizing pneumonia (OP) as the most common histological diagnosis (54.8%). Variables independently associated with hospital mortality were age (odds ratio 1.070, 95%CI 1.006–1.138; p = 0.031) and the presence of OP (0.182, [0.036–0.926]; p = 0.040), the latter being confirmed in the survival analysis (log-rank p = 0.040). In contrast, a change in therapy based on histopathology alone occurred in 40.5%, and there was no evidence of improved survival in those patients. Conclusions Transbronchial lung biopsy remains a valuable alternative to surgical lung biopsy in mechanically ventilated critically ill patients. However, the high diagnostic yield must be weighed against potential adverse events and limited consequence of the histopathological result regarding treatment decisions in such patients.
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Affiliation(s)
- Alessandro Ghiani
- Department of Pulmonary and Respiratory Medicine, Schillerhoehe Lung Clinic (Robert-Bosch-Hospital GmbH, Stuttgart), Solitudestr. 18, 70839, Gerlingen, Germany.
| | - Claus Neurohr
- Department of Pulmonary and Respiratory Medicine, Schillerhoehe Lung Clinic (Robert-Bosch-Hospital GmbH, Stuttgart), Solitudestr. 18, 70839, Gerlingen, Germany.,German Center for Lung Research (DZL), Germany, Germany
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23
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Quigley N, Gagnon S, Fortin M. Aetiology, diagnosis and treatment of moderate-to-severe haemoptysis in a North American academic centre. ERJ Open Res 2020; 6:00204-2020. [PMID: 33123556 PMCID: PMC7569161 DOI: 10.1183/23120541.00204-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022] Open
Abstract
Significant haemoptysis is a frightening event for patients and clinicians alike. There is a paucity of contemporary literature on the subject. A retrospective analysis of hospitalisations for haemoptysis of more than 50 mL·day−1 in a tertiary referral centre during a 5-year period was performed. Patient's characteristics, haemoptysis aetiology, management and outcome were individually recorded. The aim of this study was to detail the causes of moderate (50–200 mL·day−1) to severe (>200 mL·day−1) haemoptysis along with the diagnostic measures and treatment options used in their management in a 21st century, tertiary-care North American centre. A total of 165 hospitalisations for moderate-to-severe haemoptysis were included in the analysis. Lung cancer (30.3%) and bronchiectasis (27.9%) proved to be most frequent aetiologies. Computed tomography (CT) imaging and bronchoscopy were complementary in identifying the source of bleeding. Bronchial artery embolisation (BAE) was the most common treatment approach (61.8%) and resulted in initial bleeding control in 73.5% of cases. In-hospital mortality was 13.9%, varying from 3.3% in the moderate group to 24.7% in the severe group. Despite being the favoured approach in patients with more severe bleeding, initial BAE therapy was associated with a trend towards lower mortality compared to initial non-BAE therapy. In summary, lung cancer and bronchiectasis were the main causes of moderate-to-severe haemoptysis in our population, CT and bronchoscopy are complementary in identifying the source of bleeding, bleeding volume is associated with outcomes and BAE is a key management tool. In a contemporary North American population, lung cancer and bronchiectasis proved to be the leading causes of moderate-to-severe haemoptysis while CT and bronchoscopy appeared complementary in localising the source of bleedinghttps://bit.ly/2BFLvOT
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Affiliation(s)
- Nicholas Quigley
- Dept of Respiratory Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval (Québec Heart and Lung Institute), Québec City, QC, Canada
| | - Sébastien Gagnon
- Dept of Respiratory Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval (Québec Heart and Lung Institute), Québec City, QC, Canada
| | - Marc Fortin
- Dept of Respiratory Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval (Québec Heart and Lung Institute), Québec City, QC, Canada
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24
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Ahn JH. An update on the role of bronchoscopy in the diagnosis of pulmonary disease. Yeungnam Univ J Med 2020; 37:253-261. [PMID: 32891075 PMCID: PMC7606953 DOI: 10.12701/yujm.2020.00584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 08/08/2020] [Indexed: 12/25/2022] Open
Abstract
Bronchoscopy has evolved over the past few decades and has been used by respiratory physicians to diagnose various airway and lung diseases. With the popularization of medical check-ups and growing interest in health, early diagnosis of lung diseases is essential. With the development of endobronchial ultrasound, ultrathin bronchoscopy, and electromagnetic navigational bronchoscopy, bronchoscopy has been able to widen its scope in diagnosing pulmonary diseases. In this review, we have described the brief history, role, and complications of bronchoscopy used in diagnosing pulmonary lesions, from simple flexible bronchoscopy to bronchoscopy combined with several up-to-date technologies.
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Affiliation(s)
- June Hong Ahn
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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25
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Effects of Tranexamic Acid on Hemoptysis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clin Drug Investig 2020; 40:789-797. [DOI: 10.1007/s40261-020-00946-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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26
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McCann MD, Newlon C, Krawiec C. Hypoxemia without Respiratory Distress: Hereditary Hemorrhagic Telangiectasia in a Child. J Pediatr Intensive Care 2020; 10:155-158. [PMID: 33884218 DOI: 10.1055/s-0040-1710499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022] Open
Abstract
Hereditary hemorrhagic telangiectasia (HHT) is an underrecognized genetic disorder of vascular development in pediatric patients. Its presentation can range from mild cutaneous findings to life-threatening hemorrhage from arteriovenous malformations. Clinical diagnosis can be challenging in the pediatric population as disease manifestations evolve over time and may be difficult to identify in younger patients. This case highlights how nonspecific symptoms and signs in the preanesthesia period can be misleading, potentially placing a patient with unrecognized HHT at risk for significant morbidity and mortality.
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Affiliation(s)
- Michael D McCann
- Department of Pediatrics, Penn State Hershey Children's Hospital, Pennsylvania, United States
| | - Claire Newlon
- Department of Pediatrics, Penn State Hershey Children's Hospital, Pennsylvania, United States
| | - Conrad Krawiec
- Department of Pediatrics, Pediatric Critical Care Medicine, Penn State Hershey Children's Hospital, Pennsylvania, United States
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27
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Inhaled TXA for cases of massive hemoptysis. Am J Emerg Med 2020; 38:156-157. [DOI: 10.1016/j.ajem.2019.05.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 05/29/2019] [Indexed: 11/22/2022] Open
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Davidson K, Shojaee S. Managing Massive Hemoptysis. Chest 2020; 157:77-88. [DOI: 10.1016/j.chest.2019.07.012] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/02/2019] [Accepted: 07/11/2019] [Indexed: 12/26/2022] Open
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Simon RP, Oromendia C, Sanso LM, Ramos LG, Rajwani K. Bronchoscopic delivery of aminocaproic acid as a treatment for pulmonary bleeding: A case series. Pulm Pharmacol Ther 2019; 60:101871. [PMID: 31783097 DOI: 10.1016/j.pupt.2019.101871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/21/2019] [Accepted: 11/25/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Bronchoscopy is an essential therapeutic modality in the treatment of pulmonary bleeding. Although numerous endoscopic treatments exist, topical ε-aminocaproic acid has not been described in the literature. This study documents the use of this novel treatment for pulmonary bleeding and compares it to available evidence for tranexamic acid, a similar anti-fibrinolytic agent. DESIGN Case-series study. SETTING ICU and general inpatient floors of a tertiary medical center. PATIENTS Forty-six patients receiving endobronchial ε-aminocaproic acid for the treatment or prevention of pulmonary bleeding. MEASUREMENTS AND MAIN RESULTS Of the 46 patients included in the study, 41.6% and 13% presented with non-massive and massive hemoptysis, respectively. In patients with active pulmonary bleeding, endobronchial application of ε-aminocaproic acid and accompanying therapies resulted in cessation of bleeding in 94.7% of cases. A total of six patients received ε-aminocaproic acid monotherapy; in three patients with active bleeding, 100% achieved hemostasis after treatment. Of the 36 patients successfully treated for active pulmonary bleeding, 27.8% had recurrent bleeding within 30 days. Thirty-day adverse events were as follows: death (10 patients), deep vein thrombosis (2 patients), renal failure (2 patients), and stroke (2 patients). CONCLUSIONS Endobronchial administration of ε-aminocaproic acid during bronchoscopy may be a safe and efficacious option in the treatment and prevention of pulmonary bleeding. Further studies are necessary to better define ε-aminocaproic acid's safety profile, optimal routes of administration, and comparative effectiveness to tranexamic acid.
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Affiliation(s)
- Russell P Simon
- Department of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Clara Oromendia
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | - Lourdes M Sanso
- Department of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Liz G Ramos
- Department of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Kapil Rajwani
- Department of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA
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Love RL, Sharma N, Chong K. Unusual presentation of haemoptysis following accidental inhalation of the 'superwarfarin' rodenticide brodifacoum. BMJ Case Rep 2019; 12:12/11/e230044. [PMID: 31767603 DOI: 10.1136/bcr-2019-230044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Haemoptysis is a worrying symptom for patients and can represent a diagnostic challenge for clinicians. We present the case of a 56-year-old woman who presented to the emergency department with acute haemoptysis and associated sudden-onset dyspnoea. The patient remained haemodynamically stable and there was no demonstrable drop in haemoglobin concentration. Following rigorous investigations, on further questioning, the patient recalled inadvertent inhalation of the rodenticide brodifacoum. This exposure was deemed to represent the cause of their acute haemoptysis, which subsequently fully resolved without intervention.
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Affiliation(s)
- Ryan Laurence Love
- Department of Respiratory Medicine, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Naveen Sharma
- Department of Radiology, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Katie Chong
- Department of Respiratory Medicine, East and North Hertfordshire NHS Trust, Stevenage, UK
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31
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Ansari A, Cobert J, Navuluri N, Cheng G, Haney JC, Welsby I. Intrapulmonary Activated Factor VII for Hemoptysis Complicating Pulmonary Thromboendarterectomy. Ann Thorac Surg 2019; 109:e243-e245. [PMID: 31470015 DOI: 10.1016/j.athoracsur.2019.06.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 11/29/2022]
Abstract
Massive hemoptysis represents a life-threatening disorder that has numerous different causes. The development of recombinant factor concentrates has allowed for novel treatments in this emergency setting. This report describes a patient with chronic thromboembolic pulmonary hypertension who underwent pulmonary thromboendarterectomy. The postoperative course was complicated by massive hemoptysis resulting in severe hypoxemia that required extracorporeal membrane oxygenation and multiple daily blood transfusions. After failure of conservative and interventional approaches, recombinant factor VII was administered by bronchial isolation. After treatment, the patient's hemoptysis dramatically resolved, with eventual hospital discharge and excellent function at follow-up. This case presents the use of intrapulmonary activated factor VII to control massive hemoptysis.
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Affiliation(s)
- Andrea Ansari
- Duke University School of Medicine, Durham, North Carolina
| | - Julien Cobert
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
| | - Neelima Navuluri
- Department of Pulmonology and Critical Care, Duke University Medical Center, Durham, North Carolina
| | - George Cheng
- Division of Interventional Pulmonology, Department of Pulmonology and Critical Care, Duke University Medical Center, Durham, North Carolina
| | - John C Haney
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ian Welsby
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina; Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
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Mondoni M, Carlucci P, Cipolla G, Fois A, Gasparini S, Marani S, Centanni S, Sotgiu G. Bronchoscopy to assess patients with hemoptysis: which is the optimal timing? BMC Pulm Med 2019; 19:36. [PMID: 30744616 PMCID: PMC6371580 DOI: 10.1186/s12890-019-0795-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/29/2019] [Indexed: 01/12/2023] Open
Abstract
Background Bronchoscopy plays a key role to diagnose the etiology, to localize the site, and to identify the sources of the bleeding in patients with hemoptysis, but the ideal timing of an endoscopic examination is still unclear. Methods We performed a secondary analysis of an observational and multicenter study, aimed at evaluating the epidemiology of hemoptysis in Italy and the diagnostic yield of the most frequently prescribed examinations. The aim of the study was to evaluate whether an early bronchoscopy (i.e., performed during active bleeding/≤48 h after hemoptysis stopped) helps localize bleeding (i.e., site, lobe, lung) and increase diagnostic yield in comparison with a delayed examination. Results Four hundred eighty-six consecutive adult patients (69.2% males; median [IQR] age: 67 [53–76] years) with hemoptysis requiring an etiological diagnosis and undergoing bronchoscopy were recruited. Bleeding focus could be located more frequently in case of moderate-severe bleedings than in cases of mild hemoptysis (site: 70/154, 45.4%, VS. 73/330, 22.1%; p-value < 0.0001; lobe: 95/155, 61.3%, VS. 95/331, 28.7%; p-value < 0.0001; lung: 101/155, 65.1%, VS. 111/331, 33.5%; p-value < 0.0001). Early bronchoscopy showed a higher detection rate of bleeding source in comparison with delayed examination (site: 76/214, 35.5%, VS. 67/272, 24.6%; p-value = 0.01; lobe: 98/214, 45.8%, VS. 92/272, 33.8%; p-value = 0.007; lung: 110/214, 51.4%, VS. 102/272, 37.5%; p-value = 0.002). Early bronchoscopy did not provide any advantages in terms of increased diagnostic yield, in the total cohort (113/214, 52.8%, VS. 123/272, 45.2%; p-value = 0.10) and in the severity subtypes (mild: 56/128, 43.8%, VS. 88/203, 43.4%; p-value = 0.94; moderate-severe: 57/86, 66.2%, VS. 35/69, 50.7%; p-value = 0.051). Conclusions Early bronchoscopy helps detect bleeding sources, particularly in cases of moderate-severe hemoptysis, without increasing diagnostic accuracy. Trial registration ClinicalTrials.gov (identifier: NCT02045394).
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Affiliation(s)
- Michele Mondoni
- Department of Health Sciences, Respiratory Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, San Paolo Hospital, Via Di Rudinì n. 8, 20142, Milan, Italy.
| | - Paolo Carlucci
- Department of Health Sciences, Respiratory Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, San Paolo Hospital, Via Di Rudinì n. 8, 20142, Milan, Italy
| | | | - Alessandro Fois
- Lung Disease Unit, Department of Medical, Surgical, Experimental Sciences, University of Sassari, Sassari, Italy
| | - Stefano Gasparini
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.,Pulmonology Unit, AOU "Ospedali Riuniti", Ancona, Italy
| | - Silvia Marani
- ASST Mantova, Dipartimento Cardio-Toraco-Vascolare, Unità Operativa di Pneumologia e UTIR, Mantova, Italy
| | - Stefano Centanni
- Department of Health Sciences, Respiratory Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, San Paolo Hospital, Via Di Rudinì n. 8, 20142, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical, Experimental Sciences, University of Sassari, Sassari, Italy
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Sancho-Chust JN, Cases Viedma E, Martinez Tomas R, Chiner Vives E. Argon plasma coagulation for management of hemoptysis in endobronchial metastasis from soft-tissue sarcoma. Respir Med Case Rep 2019; 28:100919. [PMID: 31428557 PMCID: PMC6695272 DOI: 10.1016/j.rmcr.2019.100919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/31/2019] [Accepted: 07/31/2019] [Indexed: 12/02/2022] Open
Abstract
Hemoptysis is a manifestation of a wide variety of diseases. Endobronchial metastases from nonpulmonary neoplasms are unusual. Among these causes, soft-tissue sarcoma is also discretely rare and scarcely documented. Argon plasma coagulation is a useful tool for the interventional pulmonologist that can allow control of bleeding from these lesions. Here we report a case of hemoptysis from an endobronchial metastasis of soft-tissue sarcoma. Argon plasma coagulation of the bleeding lesion was performed successfully.
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Affiliation(s)
- Jose N. Sancho-Chust
- Respiratory Department, Sant Joan d’Alacant University Hospital, Ctra. Alacant-València s/n, 03550, Sant Joan d’Alacant, Spain
- Corresponding author. Respiratory Department Sant Joan University Hospital, Ctra. Alacant-València, s/n, 03550, Sant Joan d’Alacant, Spain.
| | - Enrique Cases Viedma
- Respiratory Endoscopy Unit, La Fe University and Polytechnic Hospital, Av. Fernando Abril Martorell 106, 46026, València, Spain
| | - Raquel Martinez Tomas
- Respiratory Endoscopy Unit, La Fe University and Polytechnic Hospital, Av. Fernando Abril Martorell 106, 46026, València, Spain
| | - Eusebi Chiner Vives
- Respiratory Department, Sant Joan d’Alacant University Hospital, Ctra. Alacant-València s/n, 03550, Sant Joan d’Alacant, Spain
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Trauma Airway Management: Induction Agents, Rapid Versus Slower Sequence Intubations, and Special Considerations. Anesthesiol Clin 2018; 37:33-50. [PMID: 30711232 DOI: 10.1016/j.anclin.2018.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Trauma patients who require intubation are at higher risk for aspiration, agitation/combativeness, distorted anatomy, hemodynamic instability, an unstable cervical spine, and complicated injuries. Although rapid-sequence intubation is the most common technique in trauma, slow-sequence intubation may reduce the risk for failed intubation and cardiovascular collapse. Providers often choose plans with which they are most comfortable. However, developing a flexible team-based approach, through recognition of complicating factors in trauma patients, improves airway management success.
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Wand O, Guber E, Guber A, Epstein Shochet G, Israeli-Shani L, Shitrit D. Inhaled Tranexamic Acid for Hemoptysis Treatment. Chest 2018; 154:1379-1384. [DOI: 10.1016/j.chest.2018.09.026] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/29/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022] Open
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Rasmussen's pseudoaneurysm- case report. Respir Med Case Rep 2018; 25:150-153. [PMID: 30181948 PMCID: PMC6120435 DOI: 10.1016/j.rmcr.2018.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 08/22/2018] [Accepted: 08/22/2018] [Indexed: 12/02/2022] Open
Abstract
Background Pulmonary aneurysms and pseudoaneurysms have various etiologies; however, the term Rasmussen's pseudoaneurysm refers specifically to a focal dilatation of a branch of the pulmonary artery into adjacent tuberculous cavity. The incidence of such tuberculosis related pulmonary vascular complication is extremely rare, hence, under recognized by many physicians. Management of pulmonary pseudoaneurysms is challenging as they present by life-threatening hemoptysis. Furthermore, contrary to the most causes of massive hemoptysis their bleeding is of pulmonary rather than bronchial artery origin. Prompt diagnosis and early interventions are needed as a very high mortality rate is associated with this illness. Case description We are reporting on a case of a young male who was presented to our hospital with recurrent episodes of massive hemoptysis and was diagnosed to have pulmonary tuberculosis. Despite being actively treated, his hemoptysis persisted. We describe in this case the role of different diagnostic modalities and the available therapeutic options. Conclusion Rasmussen's psudoaneurysm is rare and potentially lethal pulmonary vascular complication of tuberculosis. It should be considered in the differential diagnosis of hemoptysis in patients known or suspected to have pulmonary tuberculosis. In such cases, multidetector computed tomography (MDCT) scanning is the investigation of choice to confirm the diagnosis and to localize the source of bleeding prior to the therapeutic interventions. Head to head comparison between interventional radiology procedures and surgery in treatment of pulmonary psudoaneurysms is lacking, thus, choice depend on the availability and local expertise.
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