1/52. Munchausen's syndrome. A case of factitious hemoptysis.Factitious hemoptysis is the bleeding type of Munchausen's syndrome, rarely reported in the literature (only seventeen cases). After a careful and detailed literature review, the authors report the case of a 22-year-old working-woman, with a history of asthma, Mediterranean anaemia and recurrent hemoptysis, who was admitted several times to the cardiovascular and Respiratory Sciences Department in the Carlo Forlanini Hospital in 1994 for an asthmatic attack and wheeziness at rest. During the admissions the patient underwent laboratory tests (such as the examination of sputum specimens, urinalysis, tuberculin test, cold agglutinins and pneumotropic virus tests) and diagnostic studies (fiberoptic bronchoscopy with bronchoalveolar lavage, computerized tomography and radiography of the chest, bronchial arteriography, bronchography, perfusion and ventilation lung scan), because she continually presented with hemoptysis, in order to spot and discover the nature of the bleeding. Since such examinations failed (a few of them-namely fiberoptic bronchoscopies--were even performed when she was coughing up blood) and psychiatric consultations revealed the presence of psychologically traumatic events in the patient's history which could explain the psychopathic traits of her personality (in fact she was aggressive and unstable in interpersonal relations), a diagnosis of factitious hemoptysis in Munchausen's syndrome was made.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
2/52. Haemoptysis after breath-hold diving.Pulmonary oedema has been described in swimmers and self-contained underwater breathing apparatus (Scuba) divers. This study reports three cases of haemoptysis secondary to alveolar haemorrhage in breath-hold divers. Contributory factors, such as haemodynamic modifications secondary to immersion, cold exposure, exercise and exposure to an increase in ambient pressure, could explain this type of accident. Furthermore, these divers had taken aspirin, which may have aggravated the bleeding.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
3/52. Management of aortobronchial fistula with an aortic stent-graft.Aortobronchial fistula presenting as massive hemoptysis is a rapidly fatal process that is extremely difficult to manage. We report a case in which endovascular occlusion of a fistula between a thoracic aortic pseudoaneurysm and lung was successfully managed by placement of an aortic endovascular stent-graft. Stent-grafting is a promising technique in managing complications of thoracic aneurysms and grafts.- - - - - - - - - - ranking = 7.8113442357664E-5keywords = process (Clic here for more details about this article) |
4/52. Diffuse alveolar hemorrhage following administration of tirofiban or abciximab: a nemesis of platelet glycoprotein IIb/IIIa inhibitors.We describe three patients who developed severe pulmonary hemorrhage following administration of tirofiban (one patient) and abciximab (two patients). Pulmonary hemorrhage associated with abciximab use has been described, but to the best of our knowledge there has been no previous reports of this complication with tirofiban. Cathet. Cardiovasc. Intervent. 49:181-184, 2000.- - - - - - - - - - ranking = 4keywords = alveolar (Clic here for more details about this article) |
5/52. North American paragonimiasis. A case report.BACKGROUND: paragonimiasis is a parasitic infection with a predilection for pulmonary involvement. paragonimus species occur throughout the world and exist in nature in a snail-crustacean-mammalian life cycle. Human disease is most frequently encountered in cultures that ingest raw or undercooked crustaceans. North American paragonimiasis, caused by an endemic paragonimus species, paragonimus kellicotti, predominantly causes disease in carnivorous and omnivorous animals but may cause human disease if the intermediate host, the crayfish, is ingested raw or undercooked. CASE: A previously healthy, 21-year-old male was infected with P kellicotti and developed parasitic hemoptysis. The disease was contracted through the ingestion of local, undercooked crayfish. diagnosis was established through the morphologic examination of eggs in the cytologic preparation of bronchioalveolar lavage fluid. The patient was successfully treated with praziquantel and recovered without incident. CONCLUSION: paragonimiasis is a cause of parasitic hemoptysis worldwide. paragonimiasis is infrequently encountered in north america and is usually not considered in the differential diagnosis of hemoptysis unless specific risk factors are known. The cytologist or cytopathologist, therefore, may be the first to encounter the diagnostic eggs and should be familiar with this disease.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
6/52. Congenital misalignment of pulmonary vessels and alveolar capillary dysplasia: how to manage a neonatal irreversible lung disease?Congenital misalignment of pulmonary vessels (MPV) with alveolar capillary dysplasia is a rare condition consisting of anomalous veins in bronchovascular bundles, a decreased number of alveolar capillaries, and increased muscularization of pulmonary arterioles. In the literature, infants reported as having such a malformation developed respiratory distress with persistent pulmonary hypertension and ultimately died. We report the case of an infant with MPV and alveolar capillary dysplasia who was unresponsive to maximal cardiorespiratory support, including high-frequency oscillatory ventilation and inhaled nitric oxide; the infant died of pulmonary hemorrhage after 19 days, during venoarterial extracorporeal membrane oxygenation bypass. We conclude that the diagnosis of MPV and alveolar capillary dysplasia should be considered during autopsy of infants who have died of irreversible persistent pulmonary hypertension. If a lung biopsy in infants with prolonged refractory hypoxemia confirms such diagnosis before death, expensive and invasive treatments such as extracorporeal membrane oxygenation could be avoided.- - - - - - - - - - ranking = 8keywords = alveolar (Clic here for more details about this article) |
7/52. Massive pulmonary hemorrhage in a Saudi female with primary antiphospholipid syndrome.The antiphospholipid syndrome is characterized by the presence of antiphospholipid antibodies and the association of protean clinical manifestations as a result of both venous and arterial thrombosis. Because diffuse alveolar hemorrhage leading to acute respiratory failure is a rather unusual complication of antiphospholipid antibodies, this diagnosis may be overlooked or its manifestations are attributed to another disease. Presented here is a young Saudi female with primary antiphospholipid syndrome who recovered after a stormy clinical course of acute respiratory failure in the intensive care unit.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
8/52. Isolated unilateral absence of a pulmonary artery: influence of systemic circulation on alveolar capillary vessels.We report a case of isolated unilateral absence of a pulmonary artery. The first clinical symptom that was manifested in the patient was recurrent hemoptysis, and subsequent angiography revealed that the main pulmonary artery was absent in the right lung, which was being fed only from the systemic circulation. Right pneumonectomy was performed, and neither the main pulmonary artery nor its remnant was detected in the resected right lung. Histologically, there were many muscular vessels in the resected lung, with intimal proliferation, or with plexiform-like lesions. The alveolar septum was moderately thickened and alveolar capillary vessels were dilated. We examined the alveolar capillary endothelial cells of the resected lung for immunoreactivity to thrombomodulin (TM) and von willebrand factor (vWF). The endothelial cells were negative for TM and positive for vWF, while in the normal lung control group, these cells were positive for TM and negative for vWF. We considered that the hemodynamics of the systemic circulation in the resected lung caused the alteration of immunohistochemical characteristics in alveolar capillary endothelial cells.- - - - - - - - - - ranking = 8keywords = alveolar (Clic here for more details about this article) |
9/52. Idiopathic pulmonary hemosiderosis in an adult. Favourable response to azathioprine.Idiopathic pulmonary hemosiderosis (IPH) is a rare disorder characterised by intermittent, diffuse alveolar hemorrhage (DAH). Although an inflammatory pulmonary capillaritis can be evidenced in most patients with DAH, IPH is a distinct entity in which pulmonary inflammatory alterations are lacking. Most cases occur in children, although the disease has been exceptionally reported in adults too. Here, we, describe a case of IPH in a 30-year-old woman who was admitted to our hospital because of recurrent episodes of hemoptysis since the age of 21. IPH was diagnosed on the basis of: 1) an open lung biopsy showing focal alveolar edema and hemorrhage without parenchymal inflammatory alterations, 2) a bronchoalveolar lavage showing hemosiderin-laden macrophages, and 3) exclusion of infectious or immunologic causes of hemoptysis. prednisone administration could control the disease, but every attempt to lower the dose to less than 25 mg per day was followed by recurrence of hemoptysis. Then, azathioprine was started, and after three months prednisone was gradually tapered to the dose of 10 mg per day, without any relapse of the disease. These findings indicate that azathioprine, in combination with prednisone, may be an effective therapy for IPH and suggest that an immunologic mechanism could be involved in the pulmonary capillary damage underlying alveolar bleeding.- - - - - - - - - - ranking = 4keywords = alveolar (Clic here for more details about this article) |
10/52. hemoptysis provoked by voluntary diaphragmatic contractions in breath-hold divers.Pulmonary barotrauma of descent (lung squeeze) has been described in breath-hold divers when the lung volume becomes smaller than the residual volume (RV), with the effect of increased ambient pressure. However, the ratio between the total lung capacity and the RV is not the only factor that plays a role in the lung squeeze. blood shift into the thorax is another important factor. We report three cases of hemoptysis in breath-hold divers who dove for spear fishing in shallower depths than usual. All of the divers performed voluntary diaphragmatic contractions at the beginning of their ascent, while their mouths and noses were closed. We suggest that the negative intrathoracic pressure due to the forced attempt to breathe in with voluntary diaphragmatic contractions contributes to alveolar hemorrhage, since it may damage the pulmonary capillaries.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
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