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He X, Dai R, Zhou L, Lv L, Li M, Deng J, Yan D. Pheochromocytoma-induced diffuse alveolar hemorrhage after cholecystectomy: A case report and literature review. Heliyon 2024; 10:e34218. [PMID: 39091938 PMCID: PMC11292511 DOI: 10.1016/j.heliyon.2024.e34218] [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: 12/24/2023] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 08/04/2024] Open
Abstract
Diffuse alveolar hemorrhage (DAH) can be caused by various conditions, categorized as autoimmune and non-autoimmune. Immunofactor-mediated vasculitis, such as Wegener granulomatosis, microscopic polyangiitis, Goodpasture syndrome, connective tissue disorders, and antiphospholipid antibody syndrome, are common autoimmune causes. Non-autoimmune factors include infectious or toxic exposures and neoplastic conditions. The diagnosis of DAH, resulting from excessive catecholamine release from an adrenal pheochromocytoma or extra-adrenal paraganglioma, can present diagnostic challenges and necessitate prompt treatment. In this report, we present a case of pheochromocytoma that manifested as an adrenal incidentaloma (diagnosed during the management of sudden-onset DAH after cholecystectomy). Case report: A 39-year-old female patient with adrenal incidentaloma developed DAH following a cholecystectomy procedure, presenting with sudden-onset hemoptysis and dyspnea. Administration of glucocorticoids, known to precipitate pheochromocytoma crisis (PCC), was required before the cause was determined. Intubation and mechanical ventilation were necessary due to persistent hypoxemic respiratory failure and acute respiratory distress syndrome (ARDS). The patient in this case experienced two epidoses of PCC while she was on mechanical ventilation. Subsequent work-up revealed a 26 × 25 mm left adrenal adenoma with hormonal confirmation of catecholamine hypersecretion. A laparoscopic adrenalectomy was done eight months later to excise the left adrenal gland. Subsequent examination of the tissue revealed pheochromocytoma, thereby validating the initial diagnosis. Conclusion: Adrenal incidentalomas may be pheochromocytomas (adrenal incidentalomas can manifest as pheochromocytomas), even without adrenergic symptoms. It is recommended that adrenal incidentalomas undergo evaluation for pheochromocytoma before undergoing invasive surgery or receiving corticosteroid treatment. When considering potential causes of DAH without further elucidation, including a pheochromocytoma or paraganglioma (PPGLs) in the differential diagnosis is important.
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Affiliation(s)
- Xinlian He
- Department of Endocrinology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Health Science Center of Shenzhen University, Shenzhen Clinical Research Center for Metabolic Diseases, Shenzhen Center for Diabetes Control and Prevention, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, Guangdong Province, China
| | - Ruchun Dai
- Department of Endocrinology and Metabolism, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, National Clinical Research Center for Metabolic Disease, The Second XiangYa Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, China
| | - Liming Zhou
- Department of Endocrinology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Health Science Center of Shenzhen University, Shenzhen Clinical Research Center for Metabolic Diseases, Shenzhen Center for Diabetes Control and Prevention, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, Guangdong Province, China
| | - Lingbo Lv
- Department of Endocrinology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Health Science Center of Shenzhen University, Shenzhen Clinical Research Center for Metabolic Diseases, Shenzhen Center for Diabetes Control and Prevention, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, Guangdong Province, China
| | - Mingzheng Li
- Department of Endocrinology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Health Science Center of Shenzhen University, Shenzhen Clinical Research Center for Metabolic Diseases, Shenzhen Center for Diabetes Control and Prevention, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, Guangdong Province, China
| | - Jianxin Deng
- Department of Endocrinology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Health Science Center of Shenzhen University, Shenzhen Clinical Research Center for Metabolic Diseases, Shenzhen Center for Diabetes Control and Prevention, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, Guangdong Province, China
| | - Dewen Yan
- Department of Endocrinology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Health Science Center of Shenzhen University, Shenzhen Clinical Research Center for Metabolic Diseases, Shenzhen Center for Diabetes Control and Prevention, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, Guangdong Province, China
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Higashi Y, Suyama Y, Kawanobe T, Akiyama R, Hasegawa E, Kono K, Okamoto H, Kono C. A 33-Year-Old Man With Hemoptysis and Renal Dysfunction. Chest 2023; 164:e93-e99. [PMID: 37805253 DOI: 10.1016/j.chest.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 10/09/2023] Open
Abstract
CASE PRESENTATION A 33-year-old man presented with a 10-day history of fever, dry cough, and dyspnea. He reported small amounts of frank hemoptysis that occurred several times a day for the past 3 days and a reduction in urine volume. There was no joint pain, skin rash, muscle weakness, or bleeding symptoms, except for the hemoptysis. He had a medical history of childhood asthma and untreated hypertension for the past 2 years. He had no history of smoking, recent travel, medication use, or occupational inhalation.
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Affiliation(s)
- Yuko Higashi
- Departments of Respiratory Medicine, JR Tokyo General Hospital, Tokyo, Japan; Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Yasuhiro Suyama
- Department of Rheumatology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Takeshi Kawanobe
- Departments of Respiratory Medicine, JR Tokyo General Hospital, Tokyo, Japan.
| | - Reina Akiyama
- Ophthalmology, JR Tokyo General Hospital, Tokyo, Japan
| | - Eiko Hasegawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Hiroaki Okamoto
- Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Chiyoko Kono
- Departments of Respiratory Medicine, JR Tokyo General Hospital, Tokyo, Japan
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Muacevic A, Adler JR, Anjum S, Altermanini M, Ahmed YE. Diffuse Alveolar Hemorrhage: A Rare Complication of Severe Hypertension. Cureus 2023; 15:e33933. [PMID: 36819418 PMCID: PMC9937636 DOI: 10.7759/cureus.33933] [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] [Accepted: 01/14/2023] [Indexed: 01/19/2023] Open
Abstract
Severe hypertension is a rare cause of diffuse alveolar hemorrhage. We reported a case of a 43-year-old woman who presented with shortness of breath, hemoptysis, and severe hypertension. The patient was diagnosed with diffuse alveolar hemorrhage due to severe hypertension which improved after controlling her blood pressure.
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Association between High Blood Pressure in the Emergency Department and Cryptogenic Hemoptysis. J Clin Med 2022; 11:jcm11185302. [PMID: 36142950 PMCID: PMC9504639 DOI: 10.3390/jcm11185302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022] Open
Abstract
Hemoptysis is a common cause of emergency department (ED) visits. There is little data about the role of systemic hypertension as a cause of hemoptysis. The aim of this study was to evaluate the association between systemic blood pressure and the unknown etiology of hemoptysis. This retrospective study included consecutive patients who visited the ED owing to hemoptysis and underwent a chest computed tomography between January 2011 and June 2021. Details of the initial blood pressure at the ED visit were compared between two groups with identified and unidentified causes of hemoptysis. In total, 1105 adult patients were included. The etiology of hemoptysis was identified in 1042 patients (94.3%) and remained unidentified in 63 patients (5.7%). The percentage of patients with severe hypertension was significantly higher in patients with unidentified causes of hemoptysis than in those with identified causes (35% vs. 11%, p < 0.001). In multivariate analysis, age, ever-smoker, and initial systolic blood pressure were significantly associated with hemoptysis of unidentified causes. Although further studies are needed, our findings suggest a possible association between high blood pressure and cryptogenic hemoptysis.
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Hamaguchi S, Suzuki H, Hamaguchi M, Iwasaki M, Fukuda H, Takahara H, Tomita S, Suzuki Y. A rare case of alveolar hemorrhage with hypertensive emergency. Medicine (Baltimore) 2022; 101:e30416. [PMID: 36107572 PMCID: PMC9439825 DOI: 10.1097/md.0000000000030416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Alveolar hemorrhage presents with severe respiratory failure, requiring prompt diagnosis and treatment. Alveolar hemorrhage is often caused by autoimmune diseases accompanied by progressive renal dysfunction. However, few cases without autoimmune diseases occur, making diagnosis difficult. Here, we report a case of alveolar hemorrhage with hypertensive emergency. PATIENT CONCERNS A 28-year-old man presented with dyspnea and bloody sputum. His blood pressure was 200/120 mm Hg. DIAGNOSIS The chest computed tomography showed suggestive of alveolar hemorrhage. Renal dysfunction and proteinuria were observed. However, autoantibodies were not detected. Echocardiogram revealed left ventricular function decrease. Ejection fraction was 20% to 30% with no ventricular asynergy or any valvular diseases. Brain magnetic resonance imaging showed hyperintense lesions on fluid-attenuated inversion recovery in the white matter of both cerebral and right cerebellar hemispheres, which were compatible with posterior reversible encephalopathy syndrome. Renal biopsy did not reveal any immune-mediated glomerulonephritis or vasculitis, but hypertensive nephropathy was diagnosed. INTERVENTIONS Blood pressure was controlled with combination therapy using calcium channel blocker, angiotensin II receptor blocker, α1 blocker, and β blocker. OUTCOMES Alveolar hemorrhage and proteinuria improved with strict blood pressure control. CONCLUSION This case indicates that severe hypertension can possibly cause alveolar hemorrhage. Accumulating these cases is important for general physicians to diagnose the alveolar hemorrhage with hypertensive emergency in its early stage and to avoid unnecessary treatment such as immunosuppressive therapy.
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Affiliation(s)
- Sho Hamaguchi
- Department of Nephrology Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hitoshi Suzuki
- Department of Nephrology Juntendo University Urayasu Hospital, Chiba, Japan
- *Correspondence: Hitoshi Suzuki, Department of Nephrology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba 279-0021, Japan. (e-mail )
| | - Maki Hamaguchi
- Department of Nephrology Juntendo University Urayasu Hospital, Chiba, Japan
| | - Masako Iwasaki
- Department of Nephrology Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hiromitsu Fukuda
- Department of Nephrology Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hisatsugu Takahara
- Department of Nephrology Juntendo University Urayasu Hospital, Chiba, Japan
| | - Shigeki Tomita
- Department of Pathology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
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Suematsu R, Miyata J, Sano T, Watanabe C, Maki Y, Kimizuka Y, Hayashi N, Fujikura Y, Sugiura H, Shinmoto H, Taruoka A, Nagatomo Y, Adachi T, Kawana A. Diffuse Alveolar Hemorrhage Associated with Dilated Cardiomyopathy and Sleep Apnea Syndrome. Intern Med 2021; 60:1911-1914. [PMID: 33518557 PMCID: PMC8263192 DOI: 10.2169/internalmedicine.5219-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We herein report a case of diffuse alveolar hemorrhage (DAH) associated with dilated cardiomyopathy (DCM) and sleep apnea syndrome (SAS) in a 47-year-old man. The patient exhibited recurring dyspnea and bloody sputum. Chest radiography showed bilateral diffuse infiltrative opacities without pleural effusion. A bronchoscopic analysis of bronchoalveolar lavage fluid revealed hemosiderin-laden macrophages. Based on these findings, he was diagnosed with DAH. Laboratory and pathological findings ruled out the possibility of collagen diseases and vasculitis. Overnight polysomnography revealed concomitant severe obstructive SAS. Treatment with continuous positive-pressure ventilation and pharmacological therapy for DCM prevented recurrence of DAH.
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Affiliation(s)
- Ryohei Suematsu
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Jun Miyata
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Tomoya Sano
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Chie Watanabe
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Yohei Maki
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Yoshifumi Kimizuka
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Nobuyoshi Hayashi
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Yuji Fujikura
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Hiroaki Sugiura
- Department of Radiology, National Defense Medical College, Japan
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, Japan
| | - Akira Taruoka
- Division of Cardiovascular Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Yuji Nagatomo
- Division of Cardiovascular Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Takeshi Adachi
- Division of Cardiovascular Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Akihiko Kawana
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
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Nakagawa N, Hasebe N. Potential common pathophysiological pathway of hypertension-mediated organ damage in hypertensive emergency. Hypertens Res 2020; 44:124-125. [PMID: 33149268 DOI: 10.1038/s41440-020-00575-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Naoki Nakagawa
- Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan.
| | - Naoyuki Hasebe
- Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
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