Cases reported "Hemoptysis"

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1/18. Pneumococcal abscess manifesting as an anterior mediastinal mass and fatal hemoptysis.

    An elderly man had several weeks of night sweats, weight loss, and an anterior mediastinal mass on chest radiography. Computed tomographic-guided needle aspiration was nondiagnostic. Shortly after the patient's admission, three sets of blood cultures yielded streptococcus pneumoniae. Despite systemic antimicrobials, the patient had an episode of acute hemoptysis and died. autopsy showed an anterior mediastinal abscess with pneumonic involvement of the left lung. There was histologic evidence of necrotizing pneumonia and parenchymal hemorrhage, which likely resulted in fatal hemoptysis.
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2/18. 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.
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3/18. Massive hemoptysis due to mycobacterium fortuitum infection controlled with bronchial artery embolization - a case report.

    We reported a case of first reported pulmonary infection due to mycobacterium fortuitum (M. fortuitum) with massive hemoptysis, successfully treated by bronchial artery embolization (BAE). A 78-year-old male was admitted to our hospital complaining of massive hemoptysis. A biochemical examination and dna/dna hybridization revealed M. fortuitum in the culture of his sputum. He was treated by BAE, and antituberculous agents and levofloxacin. The patient remains well without recurrence more than one and a half years after the admission.
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4/18. hemoptysis following left ventricular aneurysm repair: a misleading clinical sign.

    We report on a 66-year-old man with severe hemoptysis following coronary artery bypass grafting and repair of a left ventricular septal defect after acute myocardial infarction. Initial diagnosis was delayed by misleading clinical symptoms and radiologic studies. Due to subfebrile temperature and sputum culture positive for pseudomonas aeruginosa, he had been treated with antibiotics before reoperation. At reoperation, replacement of all foreign material and reconstruction of the ventricular repair with bovine pericardium resulted in reinfection with the same organism despite prolonged antibiotic therapy after 6 months. Removal of the pericardial tissue with direct suture closure of the ventricles and interposition of omentum led to complete healing of the infection without reoccurrence after 2 years.
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5/18. Influenza A-associated bronchiolitis obliterans organizing pneumonia mimicking Wegener's granulomatosis.

    We describe a patient with bronchiolitis obliterans organizing pneumonia (BOOP) requiring respiratory support and treated with corticosteroids and cytoxan for presumed Wegener's granulomatosis (WG). The diagnosis of WG was based on clinical presentation and strongly positive stains for anti-neutrophilic cytoplasmic antibodies (cANCA). The results of an open-lung biopsy were consistent with BOOP. Although BOOP has previously been described as one of the pulmonary manifestations of WG, other more specific histologic features of WG such as capillaritis or necrotizing vasculitis were lacking. Because influenza a virus was cultured from the patient's lung tissue, final assessment of the illness focused on this as the etiologic agent triggering the pulmonary syndrome. The presence of ANCA was considered to be nonspecific. The patient's condition improved with appropriate therapy for BOOP.
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6/18. Diffuse alveolar hemorrhage in pediatric hematopoietic cell transplant patients.

    OBJECTIVE: Diffuse alveolar hemorrhage (DAH) is defined as a syndrome of hypoxia, dyspnea, infiltrates on chest radiograph, and bloody fluid on successive bronchoalveolar lavages without apparent infection. Minimal experience has been reported with DAH after hematopoietic cell transplant (HCT) in children. We reviewed the incidence, management and outcome of DAH in a pediatric HCT population. methods: Retrospective review of 138 patients undergoing allogeneic (n = 89) or autologous (n = 49) HCT at a referral children's medical center between January 1996 and April 2000. RESULTS: Seven (5.1%) of 138 patients met criteria for DAH; all were allogeneic recipients. Mean age of DAH patients was 11 years (range: 1.4-15.2). Median onset of DAH following HCT was day 24 (range: 10-50), median day of engraftment day 20 and white blood cell count 0.54 x 10(9)/L (range: < 0.1-7.03), with no difference between survivors and nonsurvivors. All patients developed clinical respiratory failure and 6 required intubation, with PaO(2)/fraction of inspired oxygen <200. patients were intubated a median of 12 days (range: 1-75). All patients experienced >1 episode of bleeding and 3 patients required reintubation after successful extubation resulting from recurrent DAH. bronchoalveolar lavage fluid cultures were negative for viruses, bacteria and fungi. All DAH patients received steroids. Three patients died with progressive pulmonary failure and other organ system involvement. Four of 7 DAH patients (57%) survived to discharge, but 3 died from disease relapse at days 116, 138, and 273 post-HCT. CONCLUSION: DAH occurred more frequently in allogeneic HCT recipients compared with autologous recipients. Onset of DAH coincided closely with white blood cell engraftment. Although associated with significant respiratory failure and need for mechanical ventilation, HCT patients can survive DAH.
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7/18. Pulmonary zygomycosis in a diabetic patient.

    We report a case of pulmonary zygomycosis in an adult male diabetic patient who presented with fever and altered sensorium initially and later developed streaky haemoptysis. bronchoscopy showed picture of necrotizing pneumonia. sputum was negative for fungal elements on admission but later bronchial wash and repeat sputum samples were positive by microscopy and culture showed growth of rhizopus species. Immediately the patient was put on amphotericin b but had a bout of massive haemoptysis and succumbed. A high index of suspicion is needed for an early diagnosis and aggressive treatment of this infection in view of the high mortality rate.
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8/18. Pulmonary phaeohyphomycosis in a patient with hemoptysis.

    A 79-year-old retired schoolteacher had a history of bronchiectasis. She developed recurrent hemoptysis requiring multiple blood transfusions. exophiala dermatitidis was cultured repeatedly from bronchial lavages. To our knowledge, this is the first documented case of isolated pulmonary phaeohyphomycosis due to E dermatitidis, and it was successfully treated with amphotericin b and 5-fluocytosine.
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9/18. Metastatic Pseudomonas endophthalmitis following bronchoscopy.

    Symptoms of uveitis developed in the left eye of a 61-year-old woman 2 weeks after bronchoscopy to investigate hemoptysis. The true diagnosis of metastatic endophthalmitis was unsuspected for 1 month. Both sputum and vitreous samples yielded pseudomonas aeruginosa when cultured. Despite aggressive medical treatment, subtotal vitrectomy and intraocular injections of antibiotics, enucleation was eventually necessary. To our knowledge this is the first reported case of metastatic endophthalmitis following bronchoscopy. It is also the first report of the concentration of ceftazidime pentahydrate in the vitreous humour of an infected human eye.
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10/18. pulmonary aspergillosis and the importance of oxalate crystal recognition in cytology specimens.

    A 62-year-old man, previously healthy but alcoholic, and who was clinically thought to have bacterial pneumonia, presented with a pulmonary infiltrate in the right apex, and suddenly died of exsanguinating hemoptysis. sputum cultures yielded aspergillus niger and candida krusei while sputum cytology revealed numerous birefringent crystals in a background of acute inflammatory exudate. autopsy findings showed invasive aspergillosis with a large mycetoma-containing cavity in the lung that was associated with localized massive oxalosis. This case further substantiates the fact that the presence of calcium oxalate crystals in pulmonary biopsy and cytology specimens can be regarded as an important diagnostic aid in the diagnosis of pulmonary aspergillosis due to A niger.
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