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

Pulmonary bullae are a common late complication in patients with emphysema. Non-communicating emphysematous bullae may expand during air travel when the ambient pressure is reduced, resulting in various forms of barotrauma including pneumothorax and air embolism. We report a 62-yr-old man with emphysema who developed hemoptysis during international commercial air travel. CT scan of the chest obtained after the travel showed air-fluid level in an enlarged bulla. He underwent resection of the bulla and had a full recovery. This is a unique presentation of stretch injury of a bulla as a form of pulmonary barotrauma occurring during commercial air travel. With the most recent ruling by the Federal Aviation Administration to allow patients with advanced chronic obstructive lung disease to travel by air with their own supplemental oxygen devices, physicians need to be aware of this type of pulmonary barotrauma and properly advise such patients who are planning to travel by air.
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PMID:Hemorrhage from an enlarged emphysematous bulla during commercial air travel. 1718 25

The definition of broncho-pulmonary aspergillosis infections in non-immunocompromised patients remains vague and a wide range of clinical, radiological and pathological entities have been described with a variety of names, i.e. simple aspergilloma, complex aspergilloma, semi-invasive aspergillosis, chronic necrotizing pulmonary aspergillosis, chronic cavitary and fibrosing pulmonary and pleural aspergillosis, pseudomembranous tracheobronchitis caused by Aspergillus, and invasive aspergillosis. However, these disease entities share common characteristics suggesting that they belong to the same group of pulmonary aspergillosis infectious disorders: 1- a specific diathesis responsible for the deterioration in local or systemic defenses against infection (alcohol, tobacco abuse, or diabetes); 2- an underlying bronchopulmonary disease responsible or not for the presence of a residual pleural or bronchopulmonary cavity (active tuberculosis or tuberculosis sequelae, bronchial dilatation, sarcoidosis, COPD); 3- generally, the prolonged use of low-dose oral or inhaled corticosteroids and 4- little or no vascular invasion, a granulomatous reaction and a low tendency for metastasis. There are no established treatment guidelines for broncho-pulmonary aspergillosis infection in non-immunocompromised patients, except for invasive aspergillosis. Bronchial artery embolization may stop hemoptysis in certain cases. Surgery is generally impossible because of impaired respiratory function or the severity of the comorbidity and when it is possible morbidity and mortality are very high. Numerous clinical cases and short retrospective series have reported the effect over time of the various antifungal agents available. Oral triazoles, i.e. itraconazole, and in particular voriconazole, appear to provide suitable treatment for broncho-pulmonary aspergillosis infections in non-immunocompromised patients.
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PMID:[Bronchopulmonary aspergillosis infections in the non-immunocompromised patient]. 1767 39

Aspergillus spp. cultured in specimens from the airways of chronic obstructive pulmonary disease (COPD) patients are frequently considered as a contaminant. However, growing evidence suggests that severe COPD patients are at higher risk of developing invasive pulmonary aspergillosis (IPA), although IPA incidence in this population is poorly documented. Some data report that COPD is the underlying disease in 1% of patients with IPA. Definitive diagnosis of IPA in COPD patients is often difficult as tissue samples are rarely obtained before death. Diagnosis is therefore usually based on a combination of clinical features, radiological findings (mostly thoracic computed tomography scans), microbiological results and, sometimes, serological information. Of 56 patients with IPA reported in the literature, 43 (77%) were receiving corticosteroids on admission to hospital. Breathlessness was always a feature of disease and excess wheezing was present in 79% of patients. Fever (>38 degrees C) was present in only 38.5%. Chest pain and haemoptysis were uncommon. Six out of 33 (18%) patients had tracheobronchitis observed during bronchoscopy. The median delay between symptoms and diagnosis was 8.5 days. The mortality rate was high: 53 out of 56 (95%) patients died despite invasive ventilation and antifungal treatment in 43 (77%) of them. In chronic obstructive pulmonary disease patients, invasive pulmonary aspergillosis currently carries a very poor prognosis. Outcome could perhaps be improved by more rapid diagnosis and prompt therapy with voriconazole.
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PMID:Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease. 1790 86

Primary tumors of the trachea are rare and can be missed because of the paucity of symptoms and findings and the difficulty in detecting them with chest radiographs. A 31-year-old male patient was admitted with complaints of shortness of breath, coughing, phlegm, and blood in the sputum. He stated that he was being treated for chronic obstructive pulmonary disease. Fiberoptic bronchoscopy revealed a vegetative mass with a wide base on the posterolateral wall of the distal one-third of the trachea. Postoperative histopathological examination revealed a typical carcinoid tumor. In patients with an unexplained cough, dyspnea, infrequent hemoptysis, and normal pulmonary imaging findings, tracheal carcinoma should be suspected. In such cases, early thoracic computed tomography and bronchoscopic examination can provide a rapid diagnosis and treatment options and prevent a false diagnosis.
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PMID:A primary tracheal carcinoid tumor masquerading as chronic obstructive pulmonary disease. 1841 59

The aim of the present study was to describe angiographic findings and embolisation results in smokers with haemoptysis. We retrospectively reviewed the clinical data and angiographic findings from 35 patients with smoking-related bronchopulmonary disease and no associated comorbidity, who were referred for embolisation for mild (n = 6), moderate (n = 14) and severe (n = 15) haemoptysis. Spirometric classification subdivided our population into: 16 patients with chronic bronchitis but no airflow limitation; and 19 patients with chronic obstructive pulmonary disease (COPD) (stage I: n = 12; stage II: n = 5; stage III: n = 2). Bronchoscopy depicted focal submucosal vascular abnormalities in three patients and only endobronchial inflammation in 32 (91%) patients. Bronchial artery angiography revealed moderate (n = 18) or severe (n = 10) hypervascularisation in 28 (80%) patients, and normal vascularisation in seven (20%). No statistically significant difference was observed between the angiographic findings and the severity of COPD, tobacco consumption or the amount of bleeding. Cessation of bleeding was obtained by embolisation in 29 out of the 34 technically successful procedures (85%), requiring surgery in three out of five patients with recurrence. Follow-up (mean duration 7 yrs) demonstrated no recurrence of bleeding in 32 (94%) out of 34 patients and excluded late endobronchial malignancy. Smokers with various stages of COPD severity may suffer from haemoptysis that is efficiently treatable by endovascular treatment.
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PMID:Cryptogenic haemoptysis in smokers: angiography and results of embolisation in 35 patients. 1935 53

Aortic aneurysm is usually a potentially life-threatening medical problem, with a 5-year survival rate of 20% if there is no surgical repair. Upper airway compression due to aortic aneurysm usually presents with wheezing, coughing, hemoptysis, dyspnea, or pneumonitis. We report a 78-year-old male patient with a history of chronic obstructive pulmonary disease who was admitted to our emergency department because of wheezing dyspnea for 2 days. Acute chronic obstructive pulmonary disease exacerbation with respiratory failure was impressed, but the patient had poor response to bronchodilators and systemic steroids treatment. Because chest radiography revealed a widening of the upper mediastinum and right lower lung collapse, fiberoptic bronchoscopy was performed and revealed narrowing at the lower portion of trachea and orifice of right main bronchus. Chest computed tomography scan showed aortic aneurysm involving the aortic arch and near the entire thoracic aorta. Because of his poor condition, surgery for aortic aneurysm was not suggested by the thoracic surgeons. We deployed expandable metallic stents in the right main stem bronchi and in the distal trachea. The patient was then weaned from mechanical ventilation a few days later.
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PMID:Metallic stents for rescuing a patient with severe upper airway compression due to aortic aneurysm. 1937 58

Infections due to Aspergillus species cause significant morbidity and mortality. Most are attributed to Aspergillus fumigatus, followed by Aspergillus flavus and Aspergillus terreus. Aspergillus niger is a mould that is rarely reported as a cause of pneumonia. A 72-year-old female with chronic obstructive pulmonary disease and temporal arteritis being treated with steroids long term presented with haemoptysis and pleuritic chest pain. Chest radiography revealed areas of heterogeneous consolidation with cavitation in the right upper lobe of the lung. Induced bacterial sputum cultures, and acid-fast smears and cultures were negative. Fungal sputum cultures grew A. niger. The patient clinically improved on a combination therapy of empiric antibacterials and voriconazole, followed by voriconazole monotherapy. After 4 weeks of voriconazole therapy, however, repeat chest computed tomography scanning showed a significant progression of the infection and near-complete necrosis of the right upper lobe of the lung. Serum voriconazole levels were low-normal (1.0 microg ml(-1), normal range for the assay 0.5-6.0 microg ml(-1)). A. niger was again recovered from bronchoalveolar lavage specimens. A right upper lobectomy was performed, and lung tissue cultures grew A. niger. Furthermore, the lung histopathology showed acute and organizing pneumonia, fungal hyphae and oxalate crystallosis, confirming the diagnosis of invasive A. niger infection. A. niger, unlike A. fumigatus and A. flavus, is less commonly considered a cause of invasive aspergillosis (IA). The finding of calcium oxalate crystals in histopathology specimens is classic for A. niger infection and can be helpful in making a diagnosis even in the absence of conidia. Therapeutic drug monitoring may be useful in optimizing the treatment of IA given the wide variations in the oral bioavailability of voriconazole.
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PMID:Aspergillus niger: an unusual cause of invasive pulmonary aspergillosis. 2029 3

Bronchoscopic lung volume reduction using endobronchial valves has been suggested as a potentially safer alternative to surgery in selected cases. Complications of this technique include pneumothoraces, pneumonia, COPD exacerbations, hemoptysis, and valve migrations. We report the case of a male patient who developed a parenchymal mass in the treated lobe after valve insertion. Due to severe emphysema, transthoracic needle aspiration was not feasible. Removal of the valves was mandatory to perform transbronchialbiopsies which revealed a non-small cell primary lung cancer. This first description illustrates the potential risk of lung cancer development following bronchoscopic lung volume reduction and highlights the different approach to diagnosis and management of indeterminate peripheral lung lesions needed in this context.
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PMID:Lung cancer following bronchoscopic lung volume reduction for severe emphysema: a case and its management. 2218 61

We present four cases of pulmonary actinomycosis in patients over 40 years of age, two of them with chronic obstructive pulmonary disease (COPD), showing an increase in productive cough, episodes of dyspnea, hemoptysis and long-term fever. Routine chest radiographs revealed segmental air-space consolidation, suggestive of unresolved pneumonia or neoplasm. Computed tomography (CT) scan showed similar findings to the ones previously described. Sputum cultures for mycobacteriae and Mantoux tests were constantly negative. Due to the poor clinical and radiodological outcome of the patients, a fine needle aspiration (FNA) was made to rule out a neoplasm. Tridimensional filamentous colonies of Actinomyces were observed in cytology. Antibiotic treatment resulted in an improvement of symptoms. The follow-up showed a decrease of the consolidation areas. Pulmonary actinomycosis is rare nowadays and clinical symptoms are unspecific and can be confused with a neoplasm process. Therefore, in patients with risk factors, symptoms of subacute pneumonia and radiologic findings of consolidation, it is advisable to consider pulmonary actinomycosis as a diagnostic possibility. It is a treatable disease and its correct diagnosis by FNA, avoids performing invasive diagnostic tests, delays in the diagnosis and allows for a complete cure by antibiotic therapy.
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PMID:[Pulmonary actinomycosis. Fine needle aspiration diagnostic]. 2252 45

A 51-year-old man, with a history of severe COPD and bilateral pneumothorax, who was under treatment for pulmonary tuberculosis due to mycobacterium avium, was admitted due to high-grade fever, weight loss, cough, and production of purulent sputum, for almost one month without any special improvement despite adequate antibiotics treatment in outpatient setting. A CT scan revealed multiple consolidations, fibrosis, scaring, and cavitary lesions in both upper lobes with newly shadows which were fungus balls inside them. Aspergillus flavius was isolated in three sputum samples, a diagnosis of chronic cavitary pulmonary aspergillosis was made, and treatment with intravenous amphotericin B was started. An initially clinical improvement was noted, and a first episode of minor hemoptysis was treated with conservative measures. Unfortunately a second major episode of hemoptysis occurred and he died almost immediately. Aspergilloma is defined as the presence of a fungus ball inside a preexisting pulmonary cavity or dilated airway and is one of the clinical conditions associated with the clinical spectrum of pulmonary colonization. Tuberculosis is the most common underling disease. Hemoptysis is the most common symptom. Antifungal antibiotics, surgical interventions, bronchial arteries embolization, and intracavity infusion of antibiotics have been proposed without always adequate sufficiency.
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PMID:Fatal Hemoptysis due to Chronic Cavitary Pulmonary Aspergillosis Complicated by Nontuberculous Mycobacterial Tuberculosis. 2256 80


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