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

Between 6/87 and 3/92 22 out of 24 patients were treated (22 by surgery) for pulmonary and pleural Aspergillus disease. The most frequent lung disorder was tuberculosis (9 x), followed by bronchiectasis (5 x), congenital lung cysts (2 x), pneumonia with abscess formation (2 x), sarcoidosis (2 x), and bronchial cancer (4 x). More than half the patients had further severe secondary diseases. 4 patients with "simple aspergilloma" and 5 patients with "complex aspergilloma" underwent lobectomy or segmentectomy without complications or recurrence. Special surgical problems occurred in 13 patients with inflammation involving pleura and chest wall (pleuro-pulmonary aspergillosis, pleural aspergillosis) and invasive lung changes (invasive pulmonary aspergillosis). 7 patients developed an empyema after lung resection, on 4 occasions with bronchopleural fistula. In 4 cases myoplasty, in 2 cases thoracomyoplasty, on 2 occasions completion pneumonectomy with omentoplasty, in one case omentoplasty alone, and on 2 occasions decortication with pleurectomy and lung resection lead to a complete cure. 2 open window thoracostomies were constructed. In 15 cases a single operation was adequate. In 7 patients up to 3 further operations were necessary. 17 patients had haemoptysis, in 10 of these cases it was recurrent. On 7 occasions life-threatening haemorrhage took place, causing death in 2 cases. These were the only deaths resulting from the lung disease. Our results show that aggressive surgical action can be successful. Myoplasty, thoracomyoplasty, and omentoplasty are, in our view, the most suitable measures for healing pleura empyemas and bronchopleural fistulae coincident with pleuro-pulmonary aspergillosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Surgical treatment of pulmonary and pleuro-pulmonary Aspergillus disease. 836 59

A case of tracheobronchopathia osteochondroplastica (TO) was diagnosed in a 68-year-old male with prolonged cough. A bronchoscopy revealed multiple nodular excrescences along the anterolateral wall of the trachea and main bronchi. Tissue specimens showed pronounced change of bronchial cartilage with massive mineralization diagnostic for TO. The literature on the subject is reviewed here. The aetiology and pathogenesis is unknown. The severity of TO range from no symptoms to severe dyspnoea, haemoptysis or pneumonitis. Treatment is seldom necessary. However, in severe cases, bronchoscopic removal of obstructing excrescences and surgery has been performed with therapeutic effect. Differential diagnosis of nodular excrescences includes amyloidosis, endobronchial sarcoidosis, calcificating lesions of tuberculosis, papilomatosis and tracheobronchial calcinosis. Awareness of the condition as a differential diagnosis to neo-plasms is important, to avoid unnecessary surgery or chemotherapy.
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PMID:Tracheobronchopathia osteochondroplastica. 933 55

The case history is presented of a patient with recurrent massive hemoptysis caused by necrotizing bronchial aspergillosis associated with sarcoidosis. The involved segments (right IX and X) were resected for treatment of the life-threatening hemoptysis. Histologic examination of the resected specimen confirmed the diagnosis. Necrotizing bronchial aspergillosis is a rare variant form of invasive pulmonary aspergillosis and has not been described previously as a cause of hemoptysis in sarcoidosis.
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PMID:Necrotizing bronchial aspergillosis as a cause of hemoptysis in sarcoidosis. 942 76

Five distinct clinical syndromes of pulmonary angiitis and granulomatosis are currently recognized: Wegener granulomatosis, lymphomatoid granulomatosis, necrotizing sarcoid granulomatosis, bronchocentric granulomatosis, and allergic angiitis and granulomatosis (Churg-Strauss syndrome). Patients typically present in middle age with fever, cough, hemoptysis, dyspnea, or chest discomfort. Upper airway involvement such as sinusitis suggests Wegener granulomatosis. Medical renal disease is associated with Wegener granulomatosis and Churg-Strauss syndrome. Asthma may be present in bronchocentric granulomatosis and Churg-Strauss syndrome. Pathologic examination of these entities demonstrates vasculitis, granulomatous inflammation, and parenchymal necrosis. The radiologic manifestations of pulmonary disease are varied, but the most typical appearance is that of multiple nodules or masses that may demonstrate cavitation. Diffuse multifocal air-space opacities with or without cavitation may also be seen. Pulmonary hemorrhage is a well-known presenting manifestation of Wegener granulomatosis and, less commonly, of Churg-Strauss syndrome. Because of the multifocal lung involvement in these diseases, pulmonary metastases and infectious causes are often considered in the differential diagnosis. Affected patients are treated with cytotoxic agents and corticosteroids. The prognosis is variable, depending on the specific syndrome, but may be favorable in the absence of significant complications.
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PMID:Pulmonary angiitis and granulomatosis: radiologic-pathologic correlation. 959 92

Adhesion molecules play an important role in inflammatory processes and influence on recruitment of effector cells. The aim of our study was to assess the percentage of T-lymphocytes expressing LFA-1, Mac-1 and ICAM-1 in bronchoalveolar fluid (BALF) and blood of patients with sarcoidosis, atopic bronchial asthma and chronic bronchitis. The reference group consisted of patients with haemoptysis or suspected of having bronchial carcinoma. Expression of adhesion molecules was revealed by /APAAP/ alkaline phosphatase anti alkaline phosphatase method. The highest percentage of lymphocytes expressing all adhesions molecules in BALF and blood was observed in patients with chronic bronchitis. Reductions of T-cells in BALF of patients with bronchial asthma and sarcoidosis may reflect of their direct binding in inflammatory sites. This studies confirm the involvement of adhesion molecules in maintenance of chronic inflammatory processes in the respiratory tract.
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PMID:[Adhesion molecules LFA-1(CD-11a), Mac-1(CD-11b) of t-lymphocytes in bronchoalveolar lavage fluid and blood in patients with chronic respiratory tract disease]. 1076 45

Aspergillosis comprises a variety of manifestations of infection. These guidelines are directed to 3 principal entities: invasive aspergillosis, involving several organ systems (particularly pulmonary disease); pulmonary aspergilloma; and allergic bronchopulmonary aspergillosis. The recommendations are distilled in this summary, but the reader is encouraged to review the more extensive discussions in subsequent sections, which show the strength of the recommendations and the quality of the evidence, and the original publications cited in detail. Invasive aspergillosis. Because it is highly lethal in the immunocompromised host, even in the face of therapy, work-up must be prompt and aggressive, and therapy may need to be initiated upon suspicion of the diagnosis, without definitive proof (BIII). Intravenous therapy should be used initially in rapidly progressing disease (BIII). The largest therapeutic experience is with amphotericin B deoxycholate, which should be given at maximum tolerated doses (e.g., 1-1.5 mg/kg/d) and should be continued, despite modest increases in serum creatinine levels (BIII). Lipid formulations of amphotericin are indicated for the patient who has impaired renal function or who develops nephrotoxicity while receiving deoxycholate amphotericin (AII). Oral itraconazole is an alternative for patients who can take oral medication, are likely to be adherent, can be demonstrated (by serum level monitoring) to absorb the drug, and lack the potential for interaction with other drugs (BII). Oral itraconazole is attractive for continuing therapy in the patient who responds to initial iv therapy (CIII). Therapy should be prolonged beyond resolution of disease and reversible underlying predispositions (BIII). Adjunctive therapy (particularly surgery and combination chemotherapy, also immunotherapy), may be useful in certain situations (CIII). Aspergilloma. The optimal treatment strategy for aspergilloma is unknown. Therapy is predominantly directed at preventing life-threatening hemoptysis. Surgical removal of aspergilloma is definitive treatment, but because of significant morbidity and mortality it should be reserved for high-risk patients such as those with episodes of life-threatening hemoptysis, and considered for patients with underlying sarcoidosis, immunocompromised patients, and those with increasing Aspergillus-specific IgG titers (CIII). Surgical candidates would need to have adequate pulmonary function to undergo the operation. Bronchial artery embolization rarely produces a permanent success, but may be useful as a temporizing procedure in patients with life-threatening hemoptysis. Endobronchial and intracavitary instillation of antifungals or oral itraconazole may be useful for this condition. Since the majority of aspergillomas do not cause life-threatening hemoptysis, the morbidity and cost of treatment must be weighed against the clinical benefit. Allergic bronchopulmonary aspergillosis (APBA). Although no well-designed studies have been carried out, the available data support the use of corticosteroids for acute exacerbations of ABPA (AII). Neither the optimal corticosteroid dose nor the duration of therapy has been standardized, but limited data suggest the starting dose should be approximately 0.5 mg/kg/d of prednisone. The decision to taper corticosteroids should be made on an individual basis, depending on the clinical course (BIII). The available data suggest that clinical symptoms alone are inadequate to make such decisions, since significant lung damage may occur in asymptomatic patients. Increasing serum IgE levels, new or worsening infiltrate on chest radiograph, and worsening spirometry suggest that corticosteroids should be used (BII). Multiple asthmatic exacerbations in a patient with ABPA suggest that chronic corticosteroid therapy should be used (BIII). Itraconazole appears useful as a corticosteroid sparing agent (BII). (ABSTRACT TRUNCATED)
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PMID:Practice guidelines for diseases caused by Aspergillus. Infectious Diseases Society of America. 1117 Sep 29

Hemoptysis is a rare but often severe event in sarcoidosis. It usually occurs in patients with advanced, fibrotic lung disease. We herein report the case of a 36-year old female patient with type II pulmonary sarcoidosis who presented with abundant hemoptysis very early during the course of her disease. Two attempts to embolize bronchial arteries remained unsuccessful and surgery was eventually required to stop the bleeding. Clinical, microbiological, radiological and pathological data indicate that haemoptysis was caused by systemic hypervascularization around sarcoidosis granuloma.
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PMID:[Massive hemoptysis during sarcoidosis]. 1121 10

Many atypical forms of sarcoidosis have been described. mediastinum-lung involvement, observed in 90% of the cases, may cause atypical manifestations: hemoptysis, chest pain, predominant pleural or proximal bronchial involvement. Diffuse "unpolished glass" images or air cavities may be observed on the chest x-ray. A rigorous diagnostic work-up is necessary for these atypical forms. Pathological confirmation is mandatory: non-caseous tuberculoid granuloma. A very wide range of extra-thoracic localizations have been described with variable clinical manifestations. In cases with no mediastinum-lung involvement, pathology data must be confronted with the notion of multiple organ dissemination to reach diagnosis.
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PMID:[Atypical forms of sarcoidosis]. 1124 Apr 27

A 49-year-old female was admitted to our hospital because of worsening of congestive heart failure on November 2000 in a state after insertion of permanent pacemaker for complete atrioventricular block in 1986, followed by a clinical history of chronic heart failure due to dilated cardiomyopathy. After admission, her general condition had been improved, but, she had massive hemoptysis suddenly and died on February 2001. At autopsy, noncaseating granulomas were observed scattering in lungs, liver and spleen, not associated with any infectious lesions, therefore indicating systemic sarcoidosis. In lungs, granulomatous arteritis in small- and medium-sized muscular arteries associated with disputation of the media and elastic laminae were observed, suggesting the direct cause of hemoptysis. This is the extremely rare case of pulmonary arteritis with systemic sarcoidosis resulting the death from massive hemoptysis.
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PMID:[An autopsy case of massive hemoptysis in systemic sarcoidosis with pulmonary granulomatous arteritis]. 1246 21

Severe thoracic sarcoidosis includes manifestations with significant clinical and functional impairment and a risk of mortality. Severe thoracic sarcoidosis can take on various clinical presentations and is associated with increased morbidity. The purpose of this article was to describe the CT findings in severe thoracic sarcoidosis and to explain some of their mechanisms. Subacute respiratory insufficiency is a rare and early complication due to a high profusion of pulmonary lesions. Chronic respiratory insufficiency due to pulmonary fibrosis is a frequent and late complication. Three main CT patterns are identified: bronchial distortion, honeycombing and linear opacities. CT can be helpful in diagnosing some mechanisms of central airway obstruction such as bronchial distortion due to pulmonary fibrosis or an extrinsic bronchial compression by enlarged lymph nodes. An intrinsic narrowing of the bronchial wall by endobronchial granulomatous lesions may be suggested by CT when it shows evidence of bronchial mural thickening. Pulmonary hypertension usually occurs in patients with end-stage pulmonary disease and is related to fibrotic destruction of the distal capillary bed and to the resultant chronic hypoxemia. Several other mechanisms may contribute to the development of pulmonary hypertension including extrinsic compression of major pulmonary arteries by enlarged lymph nodes and secondary pulmonary veno-occlusive disease. Aspergilloma colonization of a cavity is the main cause of hemoptysis in sarcoidosis. Other rare causes are bronchiesctasis, necrotizing bronchial aspergillosis, semi-invasive pulmonary aspergillosis, erosion of a pulmonary artery due to a necrotic sarcoidosis lesion, necrosis of parenchymal sarcoidosis lesions and specific endobronchial macroscopic lesions.
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PMID:CT findings in severe thoracic sarcoidosis. 1544 10


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