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1.
Ugeskr Laeger ; 186(10)2024 Mar 04.
Artigo em Dinamarquês | MEDLINE | ID: mdl-38445342

RESUMO

Swimming-induced pulmonary oedema (SIPE) is a rare but potentially life-threatening condition which occurs in otherwise healthy swimmers. This is a case report of a 62-year-old female developing severe dyspnoea, haemoptysis and hypoxia during open-water swimming. The report provides the current perspectives of SIPE regarding clinical presentation and treatment and presents theories on the pathophysiology of the condition.


Assuntos
Surdez , Edema Pulmonar , Feminino , Humanos , Pessoa de Meia-Idade , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/etiologia , Natação , Nível de Saúde , Hemoptise
2.
Chest ; 165(3): e71-e74, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38461021

RESUMO

CASE PRESENTATION: An 8-year-old girl presented with a 34-day history of cough, fatigue, and impaired exercise tolerance. She experienced cyanosis on exertion but denied fever, hemoptysis, hematuria, or seizures. Her perinatal and family histories were unremarkable, and she had no history of exposure to TB. A chest radiogram from a local clinic showed diffuse pulmonary lesions. Tuberculin skin test, interferon-γ release assay, and HIV antibody test results were all negative. Immunoglobulin levels and lymphocyte subsets were normal. The patient did not respond to IV azithromycin for 1 week for community-acquired pneumonia. She was transferred to our hospital because of progressive respiratory distress and hypoxemia.


Assuntos
Azitromicina , Tosse , Humanos , Feminino , Criança , Tosse/etiologia , Hemoptise , Dispneia , Hipóxia/complicações
3.
Eur Rev Med Pharmacol Sci ; 28(4): 1433-1438, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38436177

RESUMO

OBJECTIVE: Fiberoptic bronchoscopy (FOB) is widely used in the intensive care unit for diagnostic and therapeutic purposes. Our study aimed to evaluate FOB's indications, complications, and clinical outcomes in our intensive care unit's mechanically ventilated patients and identify the microorganisms grown in bronchoalveolar lavage (BAL) specimens. PATIENTS AND METHODS: Between January 1, 2022, and June 30, 2023, a total of 332 FOBs were performed on 178 patients in the respiratory intensive care unit. RESULTS: Patients' mean age was 64±19.4 years. Females accounted for 65 (36.6%) and males accounted for 113 (63.4%) of the cases. Leading diagnoses included pneumonia (59.5%), acute respiratory distress syndrome (ARDS) (20.7%), sepsis (17.9%), chronic obstructive pulmonary disease (COPD) attack (21.9%), pulmonary embolism (10.1%), lung malignancy (43.8%), hemoptysis (8.9%), heart failure (15.1%), neurological/neuromuscular conditions (8.4%), and post cardiopulmonary resuscitation (CPR) (2.8%). FOB purposes were BAL retrieval (43.6%), secretion clearance (30.4%), guided tracheostomy (11.7%), atelectasis (8.7%), and hemoptysis (5.4%). Hypoxemia marked the primary FOB complication (3.6%). Other issues encompassed hypotension (1.5%), bradycardia (1.2%), bleeding (1.2%), tachycardia (0.9%), and hypertension (0.6%). No statistical significance was found in arterial blood gas pH, arterial partial pressure of oxygen (PaO2), and arterial partial pressure of carbon dioxide (PaCO2) values before and after the FOB procedure (p>0.05). Predominant pathogens in aspiration samples were non-albicans Candida (28.9%), Klebsiella pneumoniae (24.8%), Pseudomonas aeruginosa (14.4%), and Acinetobacter baumannii (11.7%). CONCLUSIONS: FOB is an important diagnostic and therapeutic method with a low complication rate when performed by an experienced team with appropriate indication in the intensive care unit.


Assuntos
Broncoscopia , Hemoptise , Feminino , Masculino , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Unidades de Terapia Intensiva , Cuidados Críticos
4.
Int J Tuberc Lung Dis ; 28(3): 115-121, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38454184

RESUMO

BACKGROUNDPost-TB lung disease (PTLD) can be categorised based on physiological, radiological, and clinical abnormalities, delineating distinct clinical patterns; however, thus far the importance of this is unknown. People with PTLD have a high morbidity and increased mortality, but predictors of long-term outcomes are poorly understood.METHODSWe conducted an observational study of PTLD patients attending a tertiary hospital in South Africa between 1 October 2021 and 30 September 2022. Patient demographics, risk factors, symptoms, lung function tests and outcomes were captured.RESULTSA total of 185 patients were included (mean age: 45.2 years, SD ±14.3). Half of patients reported only one previous episode of Mycobacterium tuberculosis infection (n = 94, 50.8%). There was a statistically significant association between TB-associated obstructive lung disease (OLD) and dyspnoea (P = 0.002), chest pain (P = 0.014) and smoking (P = 0.005). There were significant associations between haemoptysis and both cavitation (P = 0.015) and fungal-associated disease (P < 0.001). Six patients (3.2%) died by study end.CONCLUSIONPTLD can affect young people even with only one previous episode of TB, and carries a high mortality rate. For the first time, clinical patterns have been shown to have meaningful differences; TB-related OLD is associated with dyspnoea, chest pain and smoking; while haemoptysis is associated with cavitary and fungal-associated disease..


Assuntos
Pneumopatias Obstrutivas , Tuberculose , Humanos , Pessoa de Meia-Idade , Dor no Peito , Dispneia/etiologia , Hemoptise/etiologia , Fatores de Risco , Tuberculose/diagnóstico , Adulto
5.
J Int Med Res ; 52(3): 3000605241237890, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38497130

RESUMO

Multi-slice computed tomography (MSCT) is the primary method for the detection and visualization of foreign bodies in the pulmonary artery because it provides high sensitivity and accuracy. It is very difficult to diagnose a patient with a non-iatrogenic pulmonary artery foreign body who does not have a history of a penetrating trauma. This case report describes a 36-year-old male that presented with coughing and haemoptysis. Based on conventional coronal and cross-sectional CT, the foreign body was misdiagnosed as pulmonary tuberculosis and pulmonary artery thrombosis. During treatment of the bronchial artery embolization and anti-tuberculosis therapy, the patient continued to experience haemoptysis. After further analysis of the pulmonary artery CT angiography images and curved multiplane reconstruction, an approximately 6-cm long toothpick was identified in the pulmonary artery with an unclear entry route. After surgery to remove the toothpick, symptoms of coughing and haemoptysis were resolved. This current case demonstrated that multiplane reconstruction in MSCT can improve the detection and visualization of pulmonary artery foreign bodies, which can aid in the diagnosis of pulmonary artery diseases of unknown cause.


Assuntos
Corpos Estranhos , Artéria Pulmonar , Masculino , Humanos , Adulto , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Hemoptise/diagnóstico por imagem , Hemoptise/etiologia , Tomografia Computadorizada por Raios X/métodos , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Corpos Estranhos/complicações , Angiografia/efeitos adversos , Tosse
6.
Tokai J Exp Clin Med ; 49(1): 9-11, 2024 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-38509006

RESUMO

We report a case of chronic infection with Pasteurella multocida in the lower respiratory tract in a man with a cat. A 77-year-old man presented with recurrent hemoptysis accompanied by bronchiectasis and an opacity in the left lung on chest computed tomography. Although the patient was seropositive for Mycobacterium avium complex, repeated sputum cultures were negative for any specific pathogen. Three years later, he was referred to our hospital for hemoptysis with enhanced opacity in the lower lobe of the left lung. Culture of bronchial lavage fluid obtained via bronchoscopy was positive for P. multocida. The patient was treated with amoxicillin-clavulanic acid for 14 days and was instructed to avoid close contact with his cat. His symptoms and chest imaging findings improved and have not recurred during more than 1 1/2 years of follow up. P. multocida can cause chronic lower respiratory infections.


Assuntos
Bronquite , Pasteurella multocida , Infecções Respiratórias , Masculino , Humanos , Idoso , Hemoptise/etiologia , Infecções Respiratórias/complicações , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/tratamento farmacológico , Pulmão , Bronquite/diagnóstico , Bronquite/complicações
7.
Am J Case Rep ; 25: e942422, 2024 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-38527273

RESUMO

BACKGROUND Hemoptysis due to airway hemorrhage is treated with hemostatic agents, bronchial artery embolization (BAE), or surgical resection. We present the case of a 65-year-old man with refractory hemoptysis associated with chronic progressive pulmonary aspergillosis (CPPA) who failed to respond to combined endobronchial occlusion (EBO) with endobronchial Watanabe spigot (EWS) and BAE. CASE REPORT A 63-year-old man was diagnosed with CPPA in the right upper lung and presented to our hospital 2 years later for hemoptysis at age 65. He developed severe hemoptysis during an outpatient visit, and was urgently admitted, intubated, and ventilated to prevent choking on blood clots. Chest computed tomography showed a large mass in the apical portion of the right lung, constituting apical pleural thickening and an encapsulated pleural effusion, and dilatation in the bronchial artery supplying the right upper lung lobe. Bronchoscopy revealed the right upper lobe B1-B3 as the bleeding source. The patient had recurrent hemoptysis that was not controlled by BAE or 6 EBO+EWS procedures, and he ultimately died of hypoxemia.In the literature review, EBO+EWS can effectively control hemoptysis in appropriate cases, without the need for BAE or surgical lung resection. It is less invasive, is associated with fewer adverse events than BAE or surgery, and can achieve temporary hemostasis for severe hemoptysis. CONCLUSIONS BAE and EBO+EWS were ineffective in controlling recurrent hemoptysis caused by CPPA in this case. However, a multidisciplinary approach such as attempting hemostasis with combined EBO+EWS and BAE may be a viable treatment option in severe cases of hemoptysis.


Assuntos
Embolização Terapêutica , Aspergilose Pulmonar , Doenças Vasculares , Masculino , Humanos , Idoso , Pessoa de Meia-Idade , Hemoptise/etiologia , Hemoptise/terapia , Artérias Brônquicas , Brônquios , Embolização Terapêutica/métodos , Aspergilose Pulmonar/complicações , Aspergilose Pulmonar/terapia , Doenças Vasculares/terapia
8.
BMJ Case Rep ; 17(2)2024 Feb 29.
Artigo em Inglês | MEDLINE | ID: mdl-38423568

RESUMO

A non-smoker man in his second decade presented to a medical centre with intermittent haemoptysis over 2 years. The haemoptysis was infrequent initially to be ignored, but later, the episodes increased in amount and frequency. Routine blood tests including coagulation profile showed normal results. The chest radiography and echocardiography were normal. The contrast-enhanced CT scan of the chest showed a cystic lesion with intracystic abnormality and surrounding ground-glass opacity in the left upper lobe. The CT pulmonary angiography and invasive pulmonary angiography showed the abnormality to be a dilated pulmonary vessel draining into the left atrium, thereby confirming the diagnosis of congenital pulmonary varix contained within a lung cyst. The patient underwent a successful lobectomy following which he experienced no further haemoptysis.


Assuntos
Cistos , Pneumopatias , Varizes , Masculino , Humanos , Hemoptise/etiologia , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Pneumopatias/diagnóstico por imagem , Pneumopatias/cirurgia , Cistos/complicações , Cistos/diagnóstico por imagem , Cistos/cirurgia , Varizes/congênito
10.
BMJ Open Respir Res ; 11(1)2024 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-38350978

RESUMO

INTRODUCTION: Haemoptysis can be a feature of lung cancer and patients are typically fast-tracked for evaluation with chest radiography, contrast-enhanced CT and fibreoptic bronchoscopy (FOB). OBJECTIVE: We aim to explore whether FOB should be conducted as a component of the routine evaluation of non-massive haemoptysis, especially in the context of suspected lung cancer. METHODS: MEDLINE, EMBASE and Cochrane Library were searched for studies comparing FOB with CT in the evaluation of non-massive haemoptysis while reporting at least one of the listed primary outcomes. Primary outcomes include sensitivity of diagnostic modality with respect to lung cancer. Secondary outcomes include detection of other aetiologies such as infection. Results were synthesised using a random effects meta-analysis. Sensitivity analysis was performed for patient age group and year of study. Risk of bias assessment was carried out with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. RESULTS: A total of 2273 citations were screened and 11 studies were included, comprising a total sample size of 2015 patients with 226 confirmed cases of lung cancer. A total of 1816 and 1734 patients received a CT scan and FOB, respectively. The pooled sensitivities for detection of lung cancer using CT scan and bronchoscopy were 98% (95% CI 93.0% to 99.0%) and 86% (95% CI 63.0% to 95.0%), respectively. The sensitivity of CT was higher than that of FOB for both primary and secondary outcomes. CONCLUSION: This study suggests that bronchoscopy does not offer significant additional diagnostic benefit in the evaluation of patients presenting with non-massive haemoptysis and a negative CT scan.


Assuntos
Hemoptise , Neoplasias Pulmonares , Humanos , Hemoptise/diagnóstico , Hemoptise/etiologia , Broncoscopia/efeitos adversos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
11.
Chest ; 165(2): e33-e37, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38336441

RESUMO

CASE PRESENTATION: A 20-year-old patient with cystic fibrosis (CF) complicated by pansinusitis, pancreatic insufficiency, and diabetes presented to the local ED after an episode of large-volume hemoptysis at home. At baseline, she had advanced lung disease (FEV1, 0.97 L; 31% predicted) and upper lobe-predominant fibrocavitary changes. She was intermittently followed at a regional lung transplant center. She was previously evaluated for transplant but was not listed at the time of this presentation because of nontuberculous mycobacteria infection. She had never used tobacco, without reports of recreational inhaled drug use. Her mother had CF, and one of her brothers died in 2018 at age 24 of respiratory failure resulting from the disease.


Assuntos
Fibrose Cística , Transplante de Pulmão , Sinusite , Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Fibrose Cística/complicações , Fibrose Cística/diagnóstico , Fibrose Cística/microbiologia , Hemoptise/diagnóstico , Hemoptise/etiologia , Pulmão/microbiologia
13.
Bratisl Lek Listy ; 125(3): 153-158, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38385540

RESUMO

OBJECTIVES: The aim of the study was to evaluate pulmonary sequestration (PS). We report on location, blood supply, histology, clinical manifestation, and surgical treatment of PS, as well as on postoperative course in patients with PS. BACKGROUND: PS is a rare congenital defect of the lower respiratory tract, it represents locus minoris resistentiae of the body. Occasionally, PS is diagnosed for the first time in adulthood. METHODS: We evaluated 7 cases of PS treated at the Centre of Thoracic Surgery in Vysné Hágy, Slovakia, between years 2013 and 2020. RESULTS: Four of our seven patients were asymptomatic; the PS was found incidentally upon chest imaging. Three patients had recurrent bronchopneumonia related specifically to the intralobar type of sequestration. The most significant complication, observed in a singular patient, was a life-threatening episode of haemoptysis, requiring urgent surgical intervention. In the other 6 cases, the sequestra were surgically resected during the period when they were asymptomatic. and their sputum was confirmed negative upon microbiological examination. Anatomical resection of the affected pulmonary lobe by thoracotomy was the most common type of operation performed (4 cases, n = 7). There was no surgical mortality. CONCLUSION: To prevent complications, it is crucial to perform surgical treatment for pulmonary sequestration in patients who have sufficient functional capacity (Tab. 2, Fig. 4, Ref. 30). Text in PDF www.elis.sk Keywords: pulmonary sequestration, anatomic lobectomy, haemoptysis.


Assuntos
Sequestro Broncopulmonar , Humanos , Sequestro Broncopulmonar/diagnóstico por imagem , Sequestro Broncopulmonar/cirurgia , Hemoptise/cirurgia , Tomografia Computadorizada por Raios X , Pulmão/cirurgia , Pulmão/patologia , Toracotomia
14.
J Cyst Fibros ; 23(1): 165-168, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38184455

RESUMO

Bronchial artery embolisation (BAE) is a treatment used to manage haemoptysis. We performed a 7-year review of BAE procedures for haemoptysis at our CF centre aiming to evaluate the incidence and outcomes of patients with neurovascular complications post-BAE. Our review suggests that whilst BAE is an effective method for controlling life-threatening haemoptysis, patients are at risk of developing neurovascular complications with long term residual symptoms, and therefore careful consideration should be given in offering BAE, especially to otherwise well patients with chronic small volume haemoptysis and managing teams should have a low threshold to image symptomatic patients.


Assuntos
Fibrose Cística , Embolização Terapêutica , Humanos , Fibrose Cística/complicações , Fibrose Cística/terapia , Artérias Brônquicas , Estudos Retrospectivos , Hemoptise/diagnóstico , Hemoptise/etiologia , Hemoptise/terapia , Resultado do Tratamento , Embolização Terapêutica/efeitos adversos
15.
Eur Rev Med Pharmacol Sci ; 28(1): 310-318, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38235881

RESUMO

OBJECTIVE: Comparing the efficacy and safety of particulate [microspheres/polyvinyl alcohol (PVA)] and non-particulate [n-butyl-2-cyanoacrylate (NBCA)] agents used as the embolic agents for bronchial artery embolization (BAE) intervention in patients experiencing massive hemoptysis. PATIENTS AND METHODS: A total of 58 individuals (47 male, 11 female, standard deviation = 53.9 ± 14.8, age range = 18-84) were recruited for a retrospective study in a single unit. Thirty (51.7%) of the patients underwent BAE intervention with NBCA, and 28 (48.3%) underwent the same procedure with a particulate embolizing agent (microspheres/PVA). The demographic distribution of the patients, the etiological factors, the technical and clinical success rates, and complications were documented, with the two groups subsequently compared. RESULTS: The technical and clinical success rates following the procedure were 100% for both groups. The average follow-up duration was 34 months in the NBCA group and 33.5 months in the particulate embolizing agent group. In comparison, the rate of recurrent hemoptysis was 3.3% in the former and 17.9% in the latter, with the presence of recurrent hemoptysis not statistically different between the two groups (p = 0.097). Major complications and procedural death did not occur in either of the samples. CONCLUSIONS: The use of NBCA in BAE presents a safe and effective method. The combination of NBCA and particulate embolizing agents (PVA/microspheres) achieved equal technical and clinical success and significantly increased the hemoptysis-free survival rates in terms of life-threatening hemoptysis. MAIN POINTS: (1) In managing massive hemoptysis, using NBCA is a safe and effective method similar to using particulate embolizing agents. (2) Although not statistically significant, recurrent hemoptysis is observed less frequently in the NBCA group. (3) Technique and clinical success were relatively high and similar in the groups where NBCA and particulate embolizing agents were used.


Assuntos
Embolização Terapêutica , Embucrilato , Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Embucrilato/uso terapêutico , Hemoptise/terapia , Artérias Brônquicas , Estudos Retrospectivos , Resultado do Tratamento , Embolização Terapêutica/métodos , Álcool de Polivinil/uso terapêutico
16.
Turk Patoloji Derg ; 40(1): 63-68, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38235566

RESUMO

Pulmonary blastoma (PB) is an exceedingly rare and aggressive malignant lung neoplasm that has distinct biphasic morphology. In this report, we document rare manifestations and molecular alterations in PB. A 59-year-old non-smoker female, presented with cough and hemoptysis for 4 months. The high-resolution computed tomography chest scan showed a 3.5x2.7 cm mass in the basal segment of the left lung. Positron emission tomography and computed tomography revealed a fluorodeoxyglucose avid lobulated mass in the superior segment of the lower lobe of the left lung. On core biopsy, the diagnosis of pleomorphic carcinoma in a background of adenocarcinoma was made. A definite diagnosis of pulmonary blastoma was established on the left lung lobectomy specimen based on morphological and immunohistochemical findings. Post-surgical biopsy from the scalp swelling showed metastatic deposits. On Next Generation Sequencing (NGS), in addition to conventional CTNNB1 gene mutation, new pathogenic MYCN and ATM gene mutations were detected. Post-chemotherapy, the patient was doing well after 10 months of close follow-up. PB exhibited rare associations in the form of non-smoker status, scalp metastasis, and MYCN and ATM gene mutations on NGS in addition to conventional CTNNB1 gene mutation. Large cohort studies are required to discover the incidence, significance and therapeutic implications of these co-existing pathogenic molecular alterations in PB.


Assuntos
Neoplasias Pulmonares , Blastoma Pulmonar , Feminino , Humanos , Pessoa de Meia-Idade , Hemoptise , Pulmão/patologia , Neoplasias Pulmonares/patologia , Proteína Proto-Oncogênica N-Myc , Blastoma Pulmonar/diagnóstico , Blastoma Pulmonar/patologia , Blastoma Pulmonar/cirurgia
17.
J Cardiothorac Surg ; 19(1): 28, 2024 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-38281986

RESUMO

BACKGROUND: Mediastinal teratoma is an uncommon disease, nevertheless they represent the most common mediastinal germ cell tumors. It may grow silently for several years and remain undiagnosed until the occurrence of a complication. AIM: The main aim of this article is to illustrate the silent evolution of an anterior mediastinal teratoma for over 70 years without presenting any notable complications. CASE PRESENTATION: We present the case of a 70-year-old female, treated for hypertension referred to our department for managing a voluminous mediastinal mass, discovered fortuitously by a general practitioner in a chest X-ray. The anamnesis didn't relate any chest pain, cough, dyspnea nor hemoptysis. The clinical examination, in particular pleuropulmonary, was unremarkable. The workup (Chest X-Ray and CT scan) demonstrated a voluminous pleural mass at the expense of the right mediastinal pleura, rounded in shape, with calcified wall and fluid content. Blood tests did not demonstrate eosinophilia, and hydatid IgG serology was negative. serum human chorionic gonadotropin (hCG) and alpha fetoprotein (AFP) levels were found to be normal. The patient subsequently underwent a right posterolateral thoracotomy with resection of the lesion. The mass was dissected very carefully and then resected in toto. The macroscopic and microscopic histological examination demonstrated a mature cystic teratoma. Surgical resection was an adequate treatment and the prognosis was excellent for the patient. CONCLUSION: Cystic mature teratomas are rare thoracic tumors, often recognized by radiological examination. This article relates the silent evolution that a teratoma could have, and the late appearance of symptoms that it could have.


Assuntos
Neoplasias do Mediastino , Teratoma , Feminino , Humanos , Idoso , Teratoma/diagnóstico , Teratoma/cirurgia , Teratoma/patologia , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/cirurgia , Neoplasias do Mediastino/patologia , Tomografia Computadorizada por Raios X , Hemoptise , Toracotomia
18.
Chest ; 165(1): e11-e17, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-38199739

RESUMO

CASE PRESENTATION: A 39-year-old man who did not smoke was admitted to the hospital with recurrent cough for 1 year, accompanied by sputum expectoration (with a small amount of white phlegm), acid regurgitation, and belching. Nasal symptoms or other cough-related contributing factors were denied. The patient reported that his cough mainly occurred at nighttime and was aggravated in the supine position. Vomiting could occur when the cough was violent. He denied fever, dysphonia, chest tightness, wheezing, chest pain and hemoptysis, abdominal pain, and bloating. The patient had initially presented to the local hospital and underwent a chest CT scan. The chest CT scan showed slight and scattered patchy infiltration in bilateral lung fields and without other significant pulmonary lesions. Anti-infective treatment was administered but was not effective for ameliorating the cough symptoms. He then received an inhaled corticosteroid, antihistamines, antileukotriene agents, or proton pump inhibitors for 6 months. However, all these treatments failed to alleviate the patient's cough. He had a history of hypertension and hyperlipidemia for > 10 years and was treated with valsartan (an angiotensin II receptor blocker) and atorvastatin. In the past year, the patient had lost 10 kg of weight, and his current BMI was 27.72 kg/m2.


Assuntos
Eructação , Masculino , Humanos , Adulto , Tosse/diagnóstico , Tosse/etiologia , Vômito , Hemoptise
19.
West J Emerg Med ; 25(1): 136-143, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38205996

RESUMO

Introduction: Pulmonary embolism (PE) is an imperative diagnosis to make given its associated morbidity. There is no current consensus in the initial workup of pregnant patients suspected of a PE. Prospective studies have been conducted in Europe using a pregnancy-adapted YEARS algorithm, which showed safe reductions in computed tomography pulmonary angiography (CTPA) imaging in pregnant patients suspected of PE. Our objective in this study was 1) to measure the potential avoidance of CTPA use in pregnant patients if the pregnancy-adapted YEARS algorithm had been applied and 2) to serve as an external validation study of the use of this algorithm in the United States. Methods: This study was a single-system retrospective chart analysis. Criteria for inclusion in the cohort consisted of keywords: pregnant; older than 18; chief complaints of shortness of breath, chest pain, tachycardia, hemoptysis, deep vein thromboembolism (DVT), and D-dimer-from January 1, 2019- May 31,2022. We then analyzed this cohort retrospectively using the pregnancy-adapted YEARS algorithm, which includes clinical signs of a DVT, hemoptysis, and PE as the most likely diagnosis with a D-dimer assay. Patients within the cohort were then subdivided into two categories: aligned with the YEARS algorithm, or not aligned with the YEARS algorithm. Patients who did not receive a CTPA were analyzed for a subsequent diagnosis of a PE or DVT within 30 days. Results: A total of 74 pregnant patients were included in this study. There was a PE prevalence of 2.7% (two patients). Of the 36 patients who did not require imaging by the algorithm, seven CTPA were performed. Of the patients who did not receive an initial CTPA, zero were diagnosed with PE or DVT within a 30-day follow-up. In total, 85.1% of all the patients in this study were treated in concordance with the pregnancy-adapted YEARS algorithm. Conclusion: The use of the pregnancy-adapted YEARS algorithm could have resulted in decreased utilization of CTPA in the workup of PE in pregnant patients, and the algorithm showed similar reductions compared to prospective studies done in Europe. The pregnancy-adapted YEARS algorithm was also shown to be similar to the clinical rationale used by clinicians in the evaluation of pregnant patients, which indicates its potential for widespread acceptance into clinical practice.


Assuntos
Hemoptise , Embolia Pulmonar , Feminino , Gravidez , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Algoritmos , Bioensaio , Embolia Pulmonar/diagnóstico por imagem
20.
BMJ Case Rep ; 17(1)2024 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-38171635

RESUMO

Goodpasture syndrome is a rare autoimmune disease which affects young adults with a male preponderance and can be triggered at any point in life with a classical clinical triad of rapidly progressive glomerulonephritis, diffuse pulmonary haemorrhage and circulating anti-glomerular basement membrane antibody (anti-GBM antibody). Here we are presenting a case of a young man with hypertension in his early 20s who presented with fatigue, recurrent haemoptysis, breathlessness and decreased urine output without features of infection. He was diagnosed at an early stage of the disease with the help of clinical, serological and radiological findings. An early diagnosis with effective treatment using plasma exchange, intravenous high-dose methylprednisolone, and cyclophosphamide showed a rapid improvement in the patient's condition with an immediate decrease in anti-GBM titres and proteinuria.


Assuntos
Doença Antimembrana Basal Glomerular , Adulto Jovem , Masculino , Humanos , Doença Antimembrana Basal Glomerular/complicações , Doença Antimembrana Basal Glomerular/diagnóstico , Doença Antimembrana Basal Glomerular/terapia , Hemoptise/etiologia , Hemoptise/tratamento farmacológico , Hemorragia/tratamento farmacológico , Ciclofosfamida/uso terapêutico , Pulmão , Autoanticorpos
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