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Query: UMLS:C0019079 (hemoptysis)
 6,129 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We identified 31 patients with human immunodeficiency virus (HIV) infection and lung abscess. All patients had advanced HIV disease, and the mean CD4 cell count was 17/mm3 (range, 2-50/mm3). Twenty-two patients (71%) had previous opportunistic infections, and 24 (77%) had previous pulmonary infections. Symptoms at the time of presentation included fever (90% of patients), cough (87%), dyspnea (35%), pleuritic chest pain (26%), and hemoptysis (10%). The microbiological etiology was established for 28 patients, and the pathogens recovered were bacteria (65%), Pneumocystis carinii (6%), fungi (3%), and mixed microorganisms (16%). The pathogens included Pseudomonas aeruginosa (11), Streptococcus pneumoniae (6), P. carinii (5), Klebsiella pneumoniae (5), Staphylococcus aureus (4), Aspergillus species (3), viridans streptococcus (2), Haemophilus influenzae (1), Streptococcus milleri (1), Proteus mirabilis (1), and Cryptococcus neoformans (1). Mycobacterium tuberculosis was not isolated; two patients for whom a microbiological etiology was not established responded to antituberculous therapy. Patients were treated for 2-12 weeks; 25% of the patients received > 4 weeks of therapy. The outcome was poor: 36% of the patients had recurrences, and 19% died. In patients with AIDS, lung abscess is associated with advanced HIV infection, is due to a broad spectrum of pathogens, responds poorly to antibiotics, and has a poor prognosis.
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PMID:Lung abscess in patients with AIDS. 882 70

Bronchiectasis is pathologically defined as an abnormal and permanent dilatation of one or several bronchi. There are localized and generalized types of bronchiectasis. A vicious circle hypothesis, including an initial insult to the lower airways, impaired mucociliary clearance, microbial colonization/infection, bronchial obstruction and a local inflammatory response, has been proposed to explain the damage to the bronchial tree and the adjacent lung parenchyma. The clinical picture is variable and affected individuals might be asymptomatic or suffer from severe respiratory failure. Daily sputum production is the most common, though unspecific symptom of bronchiectasis. Other common symptoms are hemoptysis and recurrent episodes of sputum purulence, fever and pleurisy. Occasionally, major, life-threatening hemoptysis from a ruptured bronchial artery occurs. Infectious complications, e.g. lung abscess, empyema, brain abscess, and secondary amyloidosis are rarely seen today. The chest radiograph reveals changes suggestive of bronchiectasis in the majority of patients with clinically important disease. High resolution computed tomography of the lung has almost completely replaced bronchography for diagnosis, the latter rarely being of value if surgery is contemplated. No etiology is identified in about one- to two-thirds of the patients, although there are many diseases eventually associated with bronchiectasis. Prevention and therapy of underlying diseases are most important. Traditionally, the therapy of symptomatic bronchiectasis is based on antibiotics, antibronchoobstructive medication, and chest physical therapy. Surgical resection is the treatment of choice for localized symptomatic disease. Bilateral lung transplantation should be considered in younger patients with severe, generalized bronchiectasis and respiratory failure. Prospective, randomized, largescale trials supporting any of the different treatment strategies are not available, but antibiotics and surgery probably have improved the long-term outcome of many patients with bronchiectasis. In this review, some recent findings regarding the classification, pathogenesis, pathology, etiology, diagnosis, treatment, and prognosis of bronchiectasis are discussed.
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PMID:[Bronchiectasis--current aspects of an old disease]. 915 28

Congenital bronchoesophageal fistula is a rare clinical entity in adults. This anomaly may cause various symptoms such as respiratory infections, coughing bouts when eating or drinking, and even hemoptysis. The fistula can cause symptoms in childhood but may not appear until adulthood. We recently experienced a case of congenital bronchoesophageal fistula associated with esophageal diverticulum in an adult. A 63-year-old woman was admitted to our hospital due to chest discomfort, sore throat and coughing bouts when eating. An empyema with lung abscess had occurred eight years previously. Results of the physical examination were unremarkable. A Barium swallowing revealed a medium-sized diverticulum at the right anterior aspect of the esophagus, which had developed a fistulous connection with the right lower lobe bronchus. The patient was treated by fistulectomy and lobectomy of the right lower lobe. The postoperative course was smooth and uneventful.
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PMID:Congenital bronchoesophageal fistula associated with esophageal diverticulum in the adult. 933 35

The authors analysed a group of patients with lung abscesses that received surgical treatment, as well as the characteristics of their evolution. Seventeen patients with lung abscesses which underwent surgical therapy from 1984 to 1995 were analysed. The group was composed of 12 male and 5 female. The age varied from 25 to 78 years (mean-50.1 years). The etiologies were: post-pneumonic, tuberculosis, foreign-body, empyema. Two types of surgical procedures were performed: pulmonary resection and transthoracic drainage. The indication of surgery was based on the failure of clinical treatment, massive hemoptysis, pleural empyema and residual cavity wider than 2 cm after 6 weeks of clinical treatment. The patients with poor clinical conditions were selected to transthoracic drainage, the less invasive procedure. Most patients had a satisfactory post-operative evolution (58.9%). Five patients had complications (29.4%) as empyema and air leak for more than three weeks and two patients died (11.9%). Regarding the surgical technics, the pulmonary resection (lobectomy and segmentectomy) showed no morbidity and mortality. The usage of external chest tube drainage of the abscess had a morbidity of 40% and mortality of 20%. In conclusion, the complicated lung abscess is still a surgical pathology and the best approach seems to be the resection of the pulmonary segment affected. The drainage has specific indication, mainly in patients with deteriorating condition, but this procedure has high mortality and morbidity rates.
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PMID:[Surgical treatment of lung abscesses]. 959 79

Pasteurella multocida has been implicated as the cause of a variety of respiratory conditions (eg, bronchitis, pneumonia, lung abscess, empyema), but hemoptysis has been noted only in conjunction with other lung conditions. We report a case in which hemoptysis was the sole manifestation of Pasteurella infection. The patient was a middle-aged man with severe obstructive lung disease and exposure to cats. Diagnosis was made by bronchoscopy and high-dose penicillin was required for resolution.
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PMID:Hemoptysis as the sole presentation of Pasteurella multocida infection. 959 62

Positron emission tomography (PET) with 2-[F-18]-fluoro-2-deoxy-D-glucose (FDG) can demonstrate the glucose metabolism characteristics of a lesion, which may be helpful in differentiating between benign and malignant focal pulmonary lesions. Malignant cells demonstrate higher glucose metabolic activity than benign lesions. However, some inflammatory processes also show significant FDG uptake. We present two cases where high FDG uptake was found in inflammatory lesions in the lungs. The first case was that of a 38-year-old woman with chronic cough for more than 20 years. FDG PET revealed a hypermetabolic lesion with a lesion-to-background ratio of 8.0 at the posterior aspect of the right middle lung. She underwent thoracotomy and tumor resection, and was diagnosed with cryptococcosis. The second case was that of a 72-year-old woman who had pulmonary tuberculosis previously with cavitation in the left lower lobe. She suffered from fever, chills and severe hemoptysis for several days before this admission. FDG PET revealed a hypermetabolic ring at the periphery of the cavity. The lesion-to-background ratio was 7.8. Echo-guided biopsy showed no evidence of malignancy. She was treated with antibiotics and the symptoms subsided gradually. Lung abscess complicating a pre-existing cavity was diagnosed. These two cases substantiate that positive FDG PET results should be interpreted with caution in differentiating benign from malignant pulmonary abnormalities, especially in regions with a high prevalence of granulomatous lesions.
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PMID:False-positive 2-[F-18]-fluoro-2-deoxy-D-glucose positron emission tomography studies for evaluation of focal pulmonary abnormalities. 979 34

We describe the anaesthetic management of a patient undergoing lobectomy for cavitating lung abscess complicated by haemoptysis. Surgery for lung abscess is one of the absolute indications for the use of a double-lumen tube (DLT). Because pus or blood could impede fibreoptic-assisted DLT placement, a traditional, blind placement of the DLT was performed. To protect the uninvolved parts of the operated lung, ventilation of the lung with the abscess was not performed until the resection of the involved lobe had been completed.
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PMID:Lobectomy for cavitating lung abscess with haemoptysis: strategy for protecting the contralateral lung and also the non-involved lobe of the ipsilateral lung. 1157 57

This prospective study represents our experiences in using fibreoptic bronchoscopy (FOB) in the evaluation of different thoracic lesions. Over a 20-month period, 203 patients (151 males and 52 females) (age range: 15-100 years) underwent bronchoscopies. The patients had a wide range of symptoms and/or radiographic abnormalities. The majority had cough and shortness of breath; haemoptysis was a common symptom. In all, 148 patients had neoplasms and 55 had non-neoplastic lesions. The most common malignancy was bronchogenic carcinoma (91 confirmed, 33 suspected). Other neoplasms included pulmonary metastases and mediastinal tumours. The non-neoplastic chest lesions included pulmonary tuberculosis, pulmonary hydatid cyst, lung abscess and resolving chest infection and chronic bronchitis. FOB was most useful in the diagnosis of bronchogenic carcinoma (positive diagnostic yield of 73%). It was least useful in diagnosing mediastinal tumours.
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PMID:Flexible fibreoptic bronchoscopy in Basra, Iraq: a 20-month experience. 1155 6

Aspiration of oro-pharyngeal secretions and gastric content is the most frequent cause of formation of primary lung abscess. A compromised mental status (e.g. alcoholism, sedatives, stroke) and esophageal dysfunction (e.g. herniation, vomiting) are important risk factors. Aspiration pneumonia presents as a subacute disease and is usually not distinguishable from other causes of pneumonia, until typical radiological signs of cavitation and putrid sputum appear 8 to 14 days after the initial event of aspiration. Anaerobic bacteria play a pivotal role in an almost exclusively mixed spectrum of causative organisms. Aerobic pathogens are also frequently isolated, but whether they are an active part of infection or merely represent colonizers remains unclear in many instances. Differential diagnosis includes bronchial neoplasms, either as necrotizing carcinoma or as the cause of poststenotic cavernous pneumonia, other infectious diseases like tuberculosis, Pneumocystis carinii pneumonia or endocarditis with septic metastases, and lung artery embolism or vasculitis (M. Wegener). Fiberoptic bronchoscopy is extremely helpful in determining cause and etiology of the disease and should be carried out in all patients presenting with cavernous lung lesions. Bacteriological sampling should be performed using protected specimen brushing (PSB) technique. Broncho-alveolar lavage might serve as a less expensive but also less sensitive alternative measure. Since anaerobic bacteria resemble ubiquitous commensals of the oral cavity, sputum is of no use in anaerobic culture. Principal therapeutic strategy is antibiotic therapy for an extended period, usually four weeks to four months, unless radiologic changes and as well laboratory as clinical indicators of infection are completely resolved. Clindamycin, optionally supplemented with a second or third generation cephalosporin and Ampicillin/Sulbactam proved equally effective in treating aspiration pneumonia and primary lung abscess. The role of Moxifloxacin and other new flouroquinolones with their favorable pharmacodynamics is currently evaluated. Provided that antibiotics are prescribed for a sufficient period of time and patients' compliance is ensured, surgical procedures are limited to a negligible number of complications, e.g. recurrent severe hemoptysis, empyema or broncho-pleural fistula.
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PMID:[Diagnosis and therapy of abscess forming pneumonia]. 1169 90

Foreign body aspiration is a worldwide health problem which often results in life threatening complications. More than two thirds of foreign body aspirations occur among children younger than 3 years. Organic materials such as nuts, seeds, and bones are most commonly aspirated. There is a wide range of clinical presentation, and often there is not a reliable witness to supply the clinical history, especially in children. Maintaining a high index of suspicion is therefore necessary for the diagnosis. None of the imaging methods employed in such cases are diagnostic, and bronchoscopy is frequently necessary for the diagnosis as well as the treatment. In adults, removal of the foreign body can be attempted during diagnostic examination with a fibreoptic bronchoscope under local anaesthesia, which may help to avoid any further invasive procedures with more complications. When diagnosis is delayed, complications of a retained foreign body such as unresolving pneumonia, lung abscess, recurrent haemoptysis, and bronchiectasis may necessitate a surgical resection. However, some of the late complications may resolve completely after the retrieval of the foreign body, therefore, a preoperative flexible bronchoscopy should always be considered in suitable cases.
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PMID:Foreign body aspiration: clinical utility of flexible bronchoscopy. 1215 54


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