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

A retrospective study was carried out on 42 clinically diagnosed cases of venous thrombo-embolism (VTE) seen over a 10 year period. The mean age at presentation was 41 years with a sex ratio M:F of 2.5:1. The three commonest primary surgical conditions in patients with VTE were spinal trauma (16 percent), benign prostatic hypertrophy (12 percent) and head injury (10 percent). Prostatectomy was performed in 18 percent, ventral hernia repair in 12 percent and splenectomy in 9 percent. Sudden severe dyspnoea was the clinical presentation in 60 percent of patients. Central chest pain occurred in 43 percent, loss of consciousness (38 percent), haemoptysis (7 percent), mental confusion (19 percent) and lower limb swelling (14 percent). Fifty-two percent of patients presented within 10-15 days. Oral warfarin and intravenous heparin were employed in management in 45 percent. Hospital mortality from massive pulmonary embolism was 64 percent while post thrombotic syndrome occurred in 5 percent of patients.
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PMID:A 10-year review of venous thrombo-embolism in surgical patients seen in Jos, Nigeria. 1148 4

A native arteriovenous fistula is the first choice for hemodialysis access. Despite improved catheter designs and the use of internal jugular veins, thrombotic complications still occur when tunneled central venous catheters are used as an alternative. Although right atrial thrombus (RAT) is a well-characterized complication of long-term central venous cannulation, particularly when used for parenteral nutrition and chemotherapy in pediatric practice, only 9 reported cases previously have been associated with the long-term use of central venous catheters for hemodialysis. We report five cases of RAT seen at our unit between 1994 and 1998 in patients who had been dialyzed using tunneled catheters. In four of five cases, the diagnosis was made during the investigation of hemoptysis or dyspnea. In the fifth case, a screening transthoracic echocardiogram revealed the thrombus. Three of five of the patients suffered pulmonary emboli, and a fourth patient had an unexplained electromechanical dissociation cardiac arrest without definite evidence of pulmonary embolus. Our experience suggests that anticoagulated patients with RAT remain at risk of pulmonary embolism. One of our patients successfully underwent atrial thrombectomy. In four of five of our cases and four of nine cases in the literature, the central venous catheter tip was within the right atrium. Positioning of the central venous catheter tip low down in the superior vena cava or in the right atrium has been advocated to improve dialysis adequacy and to reduce the incidence of catheter thrombosis. However, placement of the catheter tip within the right atrium may be associated with an increased risk of RAT.
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PMID:Atrial thrombus and central venous dialysis catheters. 1153 97

A 29-year-old woman at 37 weeks of gestation was brought to our hospital as an emergency patient complaining of severe cough, hemoptysis and dyspnea. On arrival, we suspected that she was suffering from bronchial asthma or pulmonary embolism, but were unable to improve her respiratory condition. The decision was made to terminate gestation immediately and an emergency cesarean section was performed under spinal anesthesia. Postoperatively diagnosis of tuberculosis was made. Fortunately, there was no intramural tuberculous infection. She was a nurse. Nurses are twice as likely as the general public to contract tuberculosis. Medical workers must keep in mind that they may be infected with tuberculosis and they could also become the source of infection of tuberculosis. It is important to rule out tuberculosis when a patient, particularly a medical worker, complains of severe cough, hemoptysis and dyspnea.
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PMID:[Tuberculosis detected after emergency cesarean section]. 1222 50

A retrospective analysis of 108 patients admitted to the hospital for hemoptysis in the year 2000 was performed. The aim of the study was to clarify the etiologic distribution of hemoptysis and the relation of etiology to the severity and recurrence of it. Of the cases, 79 were men and 29 were women, and the mean age was 51.74 +/- 17.51. In 77 of the cases it was the first attack, while in 31 it was recurrent. According to the severity of hemoptysis, it was classified as "mild" (<30 cm3), "moderate" (30-100 cm3), "severe" (100-600 cm3) and "massive" (>600 cm3). Lung cancer was the leading cause of hemoptysis (34.3%) followed by bronchiectasis (25.0%), tuberculosis (17.6%), pneumonia (10.2%) and pulmonary embolism (4.6%). Statistical analysis by chi-square test revealed that most of the lung cancer patients had mild hemoptysis (odds ratio 3.5; P<0.05), and the most frequent etiology in recurrent hemoptysis was bronchiectasis (odds ratio 3.25; P=0.01). Most of the lung cancer patients were male (P=0.002). The two leading causes of hemoptysis in our study are similar to many previous reports. The high rate of tuberculosis in our study is probably due to the high prevalence of tuberculosis in our country.
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PMID:Hemoptysis: a retrospective analysis of 108 cases. 1224 12

Hemoptysis can be caused by a variety of pulmonary diseases, including parasitic infections, tuberculosis, chronic bronchitis and malignancies. Rarely, pulmonary endometriosis can present with hemoptysis and pose a diagnostic problem to clinicians. Pulmonary endometriosis can easily be confused with other clinical entities, including pulmonary embolism, pneumonia and pneumothorax. Histopathologic confirmation is difficult, since the bleeding site is not easy to locate. However, a presumptive diagnosis of pulmonary endometriosis can be made with a typical clinical history. Even so, medical therapy may be problematic, with recurrence of symptoms despite hormonal ablation. We report a case of presumptive pulmonary endometriosis in a 32- year-old woman with a history of an induced abortion, who presented with catamenial hemoptysis (approximately one tablespoon per episode) occurring in the first 3 days of menstruation over an 11-month period. She was treated with an oral contraceptive for two months. No recurrence of hemoptysis was noted during 18 months of follow-up. The approach to diagnosis and treatment of pulmonary endometriosis is reviewed.
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PMID:Catamenial hemoptysis and pulmonary endometriosis: a case report. 1235 68

Pulmonary Embolism (PE) poses an important diagnostic problem in patients with chronic obstructive pulmonary disease (COPD). Indeed PE may aggravate the already precarious respiratory state of these fragile patients. Moreover, these two conditions share common symptoms: dyspnoea, wheezing, pleural pain, haemoptysis, palpitations and signs of right cardiac insufficiency. In two studies, one retrospective and the other prospective, we investigated the incidence of PE in patients with non-infective exacerbations of their COPD. The retrospective study was carried out over two years and involved 50 COPD patients with non-infective respiratory exacerbations. In this population, 10 patients out of 50 (20%) had a documented PE. No predictive factor was identified. The prospective study was conducted over one year and COPD patients admitted to hospital with exacerbations were included in the study if they had a positive D-dimer blood test and no evidence of acute respiratory infection. 31 patients were studied with Doppler ultra-sound examination of the legs and a lung perfusion scan. The presence or absence of PE was determined and the two groups were compared. 9 patients out of 31 (29%) had a documented PE. Six of these nine patients had a deep venous thrombosis (DVT). Two predictive factors of PE were identified: existence of a DVT and a significant fall in PaO(2) from baseline state (DeltaPaO(2) > 22 mmHg). We conclude that PE is a frequent (20 to 30%) of non-infective respiratory decompensation in COPD patients. Faced with an unexplained respiratory exacerbation in these patients, a lung perfusion scan should be routinely undertaken to rule out a PE when the D-dimers are positive.
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PMID:[Pulmonary embolism and sibilant types of chronic obstructive pulmonary disease decompensations]. 1241 52

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are distinct but related aspects of the same dynamic disease process known as venous thromboembolism (VTE). An estimated 200,000 new cases occur in the United States every year, including 94,000 with PE, resulting in an incidence of 23 per 100,000 patients per year-cases. Without treatment, pulmonary embolism is associated with a mortality rate of approximately 30%, causing nearly 50,000 deaths per year. Moreover, based on post-mortem studies, two-thirds of the patients with pulmonary emboli remain undiagnosed. Clinically, PE may present as (1) isolated dyspnea, (2) pleuritic pain and/or hemoptysis, and (3) circulatory collapse. However, clinical history and examination can be notoriously misleading in reaching a diagnosis. A number of acquired etiologic risk factors (predispositions) are associated with a tendency to develop VTE. These include increasing age, immobilization, surgery, trauma, hospital or nursing home confinement, malignancy, neurologic disease with extremity paresis, as well as certain types of oral contraception and hormone replacement therapy. In addition, a variety of genetic risk factors, such as factor V Leiden, protein S or C deficiency have also been identified. However, in at least half of the instances, no predisposing factors can be identified (idiopathic PE). In the majority of cases thromboemboli originate in the deep veins of the calf or pelvis. The pathogenic conditions for VTE comprise a triad of factors and include (1) venous stasis, (2) hypercoagulable states, and (3) vascular endothelium injury. Occlusion of pulmonary arteries has variable and transient clinical and pathophysiologic consequences, involving both mechanical and reflex effects of vascular occlusion with a consecutive perfusion defect as well as the release of vasoactive and other inflammatory mediators. The objectives of this article are to present an overview of the etiologic and pathogenic factors promoting VTE as well as the pathophysiologic and inflammatory processes following PE.
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PMID:Principle mechanisms underlying venous thromboembolism: epidemiology, risk factors, pathophysiology and pathogenesis. 1258 87

BACKGROUND: The objective of the study is to determine the efficacy, safety and feasibility of home treatment with low-molecular weight heparin (LMWH) in patients with symptomatic pulmonary embolism (PE). METHODS: All patients with PE on the home treatment programme between January 1998 and December 1999 were identified. Age, sex, length of hospital stay, risk factors for PE, ventilation perfusion (V/Q) lung scanning results, baseline investigations and treatment regimen were recorded. PE was defined as a clinical diagnosis supported by a high, intermediate or low probability V/Q lung scan. The efficacy of the treatment is defined as the event rate of recurrent PE. The safety outcome is defined as the rate of haemorrhage and the mortality that was related to the treatment during the 6-month follow-up period. RESULTS: Seventy patients were identified. Of these, 68 were hospitalised initially with a mean+/-S.D. length of hospital stay of 4.0+/-3.3 (range 0-17) days; their mean+/-S.D. age was 54.6+/-20.5 (range 19-87) years. Cardiopulmonary disease was the commonest pre-existing condition and 86% patients had at least one risk factor. All except one was haemodynamically stable. During the 6 months after discharge, 20 patients (28.6%) were readmitted at least once. One patient (1.4%) had symptomatic recurrent PE, one (1.4%) had haemoptysis and the remainder had unrelated pathology. There were no episodes of serious haemorrhage, and the two deaths that occurred in this period were not due to further PE. CONCLUSION: Early discharge home for stable patients with PE treated with LMWH (tinzaparin) is feasible, effective and safe, provided that patients are clinically stable, accessible by phone, receive daily administration of LMWH and have their international normalised ratio (INR) monitored.
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PMID:Early discharge and home supervision of patients with pulmonary embolism treated with low-molecular weight heparin. 1271 24

The patient presented to the emergency room with hemoptysis and pleuritic chest pain. A chest x-ray revealed a broken dialysis catheter tip lodged in the pulmonary artery. The fractured catheter tip was removed via the femoral vein using a loop snare. As has been described for central lines and venous ports, a fractured catheter tip from a hemodialysis catheter may also lead to pulmonary embolism.
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PMID:Pulmonary embolism due to catheter fracture from a tunneled dialysis catheter. 1475 Jan 19

Overuse of the d-dimer to screen for possible pulmonary embolism (PE) can have negative consequences. This study derives and tests clinical criteria to justify not ordering a d-dimer. The test threshold was estimated at 1.8% using the method of Pauker and Kassirer. The PE rule-out criteria were derived from logistic regression analysis with stepwise backward elimination of 21 variables collected on 3148 emergency department patients evaluated for PE at 10 US hospitals. Eight variables were included in a block rule: Age < 50 years, pulse < 100 bpm, SaO(2) > 94%, no unilateral leg swelling, no hemoptysis, no recent trauma or surgery, no prior PE or DVT, no hormone use. The rule was then prospectively tested in a low-risk group (1427 patients from two hospitals initially tested for PE with a d-dimer) and a very low-risk group (convenience sample of 382 patients with chief complaint of dyspnea, PE not suspected). The prevalence of PE was 8% (95% confidence interval: 7-9%) in the low-risk group and 2% (1-4%) in the very low-risk group on longitudinal follow-up. Application of the rule in the low-risk and very low-risk populations yielded sensitivities of 96% and 100% and specificities of 27% and 15%, respectively. The prevalence of PE in those who met the rule criteria was 1.4% (0.5-3.0%) and 0% (0-6.2%), respectively. The derived eight-factor block rule reduced the pretest probability below the test threshold for d-dimer in two validation populations, but the rule's utility was limited by low specificity.
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PMID:Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. 1563 91


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