Cases reported "Hemoptysis"

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1/68. Endovascular stent graft repair of aortopulmonary fistula.

    Two patients who had aortopulmonary fistula of postoperative origin with hemoptysis underwent successful repair by means of an endovascular stent graft procedure. One patient had undergone repeated thoracotomies two times, and the other one time to repair anastomotic aneurysms of the descending aorta after surgery for Takayasu's arteritis. A self-expanding stainless steel stent covered with a Dacron graft was inserted into the lesion through the external iliac or femoral artery. The patients recovered well, with no signs of infection or recurrent hemoptysis 8 months after the procedure. Endovascular stent grafting may be a therapeutic option for treating patients with aortopulmonary fistula.
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2/68. Aorto--bronchial fistula resulting from an accidental fall one year earlier.

    A 75-year-old woman presented with massive haemoptysis 12 months after tripping over her shopping trolley. CT scanning and transoesophageal echocardiography demonstrated a traumatic false aneurysm which was confirmed at surgery to be partially ruptured. Aortobronchial fistula is an unusual cause of massive haemoptysis. It should be considered particularly in patients known to have abnormalities of the thoracic aorta.
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3/68. Thoracic aortic aneurysm: a new etiology of pulmonary cavity.

    The most frequent chest X-ray finding of descending thoracic aortic aneurysm is an enlargement of medial mediastinum. Haemoptysis caused by thoracic aortic aneurysm is rare and, normally, when it occurs, it is due to an aorto-bronchopulmonary fistula. We report the case of an 88 year-old male, heavy smoker with arterial hypertension, who had been operated on for abdominal aneurysm five years before, whose unique symptom was scant haemoptysis and radiologically presented a cavity mass in the upper left lobe. autopsy revealed that the pulmonary cavity mass was due to a descending thoracic aortic aneurysm.
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4/68. Chronic haemoptysis as delayed complication of ventricular aneurysmectomy.

    Two patients developed a ventriculo-pulmonary fistula several years after original resection of a left ventricular aneurysm. Both presented with chronic mild haemoptysis. In the first case mild haemoptysis lasted nearly 19 months, and despite a battery of non invasive and invasive investigations, diagnosis was ultimately made via exploratory thoracotomy. In the second case mild haemoptysis lasted four months and finally manifested as a large haemoptysis. diagnosis was made preoperatively using echocardiography. We recommend the use of echocardiography when haemoptysis occurs in a patient with a previous history of ventricular aneurysm repair.
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5/68. 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.
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6/68. Fatal hemoptysis in dissecting aortic aneurysm and salmonellosis: a case report.

    hemoptysis is a rare manifestation of dissecting aortic aneurysm and aortobronchial fistula may occur when an aortic aneurysm is mycotic, atherosclerotic, traumatic or postoperative. Aortobronchial fistulas are generally fatal if not treated surgically. An aggressive diagnostic approach to patients with hemoptysis and prompt surgical intervention in those suspected of aortobronchial fistulas should result in additional survivors. Imaging studies, including chest radiography, chest computerized tomography, arteriography and bronchoscopy provide useful diagnostic information. However, challenges remain when we encounter this condition. Sometimes, the final exsanguinating hemorrhage is preceded by a distinct prodromal period of intermittent hemoptysis. This allows clinicians time to recognize such fistulas and perform emergency surgery. We present a patient with this condition to alert clinicians to this potentially deadly cause of hemoptysis.
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7/68. Aortopulmonary fistula.

    BACKGROUND: Aortopulmonary fistula is an uncommon but usually fatal condition if not treated surgically. The most frequent cause is erosion of a false aneurysm of the descending thoracic aorta into the left lung. methods: review of charts of all patients who had had resection of a thoracic aortic aneurysm at the MidAmerica heart Institute (1971 to 1997) revealed three cases in which the presentation was hemoptysis resulting from an aortopulmonary fistula. The clinical features and course of each patient are summarized in this report. RESULTS: The three patients with hemoptysis due to an aortopulmonary fistula had emergency surgical intervention with no major complication. CONCLUSIONS: Any patient who has an otherwise unexplained hemoptysis and a history of a previous thoracic aortic surgical procedure or is known to have a thoracic aortic aneurysm should have appropriate clinical evaluation to exclude the presence of an aortopulmonary fistula. If an aortopulmonary fistula cannot be excluded, emergency operation should be done.
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8/68. Recurrent hemoptysis following a systemic-to-pulmonary anastomosis in a child with a complex congenital cardiomyopathy.

    A 14-year-old boy with a history of congenital cardiopathy is presented. At age 4, a left systemic-to-pulmonary fistula was performed, using a tubular prosthesis to anastomose the left subclavian artery to the left pulmonary artery. Following this procedure, he developed recurrent episodes of hemoptysis, cough, and left upper lobe consolidation. Treatment resulted in clinical but no radiologic resolution. At age 6, a new right systemic-to-pulmonary anastomosis was needed, as the left one was no longer functioning. After placement of the second shunt, the hemoptysis disappeared. At age 14, flexible bronchoscopy revealed a foreign body granuloma at the left secondary carina. Rigid bronchoscopy and laser photoresection showed it to be the left vascular prosthesis, placed 10 years before. Surgery failed to remove it.
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9/68. Clinical experiences of stenting in patients with esophago-bronchial fistula: report of four cases.

    The esophagorespiratory fistula is difficult to treat, and the patients' quality of life is generally poor due to suffering from dysphagia and dyspnea. We performed stent therapy in four cases of the esophagorespiratory fistula associated with esophageal cancer. Three of four patients showed improved symptoms, enabling oral liquid or food intake, although one died of dyspnea despite the therapy. The findings suggest that stent therapy is an effective method to close the esophagorespiratory fistula and to improve the patients' quality of life, although it is temporary and not a radical treatment.
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10/68. Late development of aortic pseudoaneurysm after coarctation repair with fistulization to the bronchial tree. A case report.

    BACKGROUND: Fistulous communication between the aorta and the tracheobronchial tree is an uncommon and serious cause of hemoptysis secondary to complications of a previous operation performed on the aorta. In cases in which an appropriate surgical intervention is carried out, the survival rate approaches 76%. This surgery is considered one of the most risky operations on the aorta, challenging the surgeon's ability to resolve the problem. methods: We present the case report of a 43-year-old female with massive hemoptysis. Her medical history disclosed repair of coarctation of the aorta (15 years before). She underwent emergency left thoracotomy; surgical exploration revealed a false aneurysm from the previous aortic patch repair which communicated to a subsegmental bronchus of the left upper lobe. RESULTS: The thoracic aorta was isolated and clamped, and the previous patch was removed. The bronchial side of the fistula was managed with left superior lobectomy and the aorta was repaired with the placement of a coated woven dacron graft onto healthy aortic tissue. CONCLUSIONS: The patient had an uneventful recovery and remains asymptomatic six months after discharge.
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