Hemosiderosis pulmonar idiopática: seguimiento de pacientes durante 25 años (1995-2019) / Idiopathic pulmonary hemosiderosis: follow-up of patients for 25 years (1995-2019)

La hemosiderosis pulmonar idiopática (HPI) es una causa de hemorragia alveolar difusa. OBJETIVO: describir la evolución de niños con HPI en nuestra institución. Se realizó una revisión retrospectiva con protocolo de seguimiento. Se reclutaron 13 pacientes, 7 hombres. Procedentes de una zona agrícola (6/13). No todos presentaron la tríada diagnóstica completa: infiltrados algodonosos (9/13), anemia (11/13), hemoptisis (9/13). Todos evidenciaron un recuento de hemosiderófagos sobre 30% en el lavado broncoalveolar. Tomografía computada de tórax: normal (5/13), patrón intersticial (5/13), vidrio esmerilado (2/13) y fibrosis (1/13). Espirometría: normal (7/13), restrictiva (4/13), obstructiva (1/13) y no efectuada (1/13). Tratamiento durante la fase aguda: bolos de metilprednisolona (7/13) o prednisona (6/13) o hidrocortisona (1/13). En la fase de mantención se administró: prednisona (13/13) más un inmunosupresor, azathioprina (12/13), hidroxicloroquina (1/13), micofenolato (1/13), más budesonida MDI (13/13). Ocho pacientes detuvieron los sangrados. Dos pacientes fallecieron y hubo cinco embarazos de curso fisiológico en 3 adolescentes. Se observó: a) diferentes modalidades de presentación que retrasaron el diagnóstico; b) gran exposición a pesticidas; c) mejor pronóstico si el diagnóstico y el tratamiento eran precoces, también en niñas adolescentes; d) la mayoría detuvo los episodios de sangrado.

Idiopathic pulmonary hemosiderosis (IPH) is a cause of diffuse alveolar hemorrhage. OBJECTIVE: to describe the evolution of children with IPH in our institution. Retrospective monitoring with a follow-up protocol was carried out. 13 patients, seven males, were recruited. From an agricultural area (6/13). Not all of patients had the complete diagnostic triad: cotton infiltrates (9/13), anemia (11/13), hemoptysis (9/13). Hemosiderin-laden macrophages counting in the bronchoalveolar lavage fluid was over 30% in all the patients. Computed chest tomography was informed as normal (5/13), interstitial pattern (5/13), ground glass (2/13) and fibrosis (1/13). Spirometry: normal (7/13), restrictive (4/13), obstructive (1/13) and not performed (1/13). Treatment during the acute phase: bolus of methylprednisolone (7/13) or prednisone (6/13) or hydrocortisone (1/13). In the maintenance phase: prednisone (13/13) plus an immunosuppressant, azathioprine (12/13), hydroxychloroquine (1/13), mycophenolate (1/13), plus budesonide MDI (13/13). Eight patients stopped the bleeding episodes. Two patients died and there were five physiological pregnancies in 3 adolescents. It was observed:(a) different modes of IPH presentation that delayed its diagnosis; (b) large exposure to pesticides; (c) prognosis improved if diagnosis and treatment were early, also in adolescent girls; (d) most of the patients stopped the bleeding episodes.

Severe Endobronchial Inflammation Induced by Aspiration of a Ferrous Sulfate Tablet / 결핵및호흡기질환

Iron supplements such as ferrous sulfate tablets are usually used to treat iron-deficiency anemia in some elderly patients with primary neurologic disorders or decreased gag reflexes due to stroke, senile dementia, or parkinsonism. While the aspiration of ferrous sulfate is rarely reported, it is a potentially life-threatening condition that can lead to airway necrosis and bronchial stenosis. A detailed history and high suspicion of aspiration are required to avoid delays in diagnosis and treatment. The diagnosis can be confirmed by bronchoscopic examination and a tissue biopsy. Early removal of the aspirated tablet prevents acute complications, such as bronchial necrosis, hemoptysis, and lobar consolidation. Tablet removal is also necessary to prevent late bronchial stenosis. We presented the first case in Korea of a ferrous sulfate tablet aspiration that induced severe endobronchial inflammation.

Analysis on medication rule in prescriptions for hemoptysis of Menghe physician Ma Peizhi based on knowledge-discovery in database / 中国中药杂志

The clinical prescriptions of hemoptysis that built by Menghe physician Ma Peizhi were collected, and were analyzed by the method of unsupervised data mining, such as association rules and clustering algorithm. From the prescriptions, we got the frequency of drugs, the association rules among drugs, 10 core drug combinations and 5 new prescriptions. Accordingly, after the analysis, Menghe physician Ma Peizhi had rich experience in the treatment of hemoptysis. His therapy for hemoptysis was clearing heat and moistening lung, dispel heat from blood to stop bleeding, and enriching yin and blood. And we can also make a conclusion that the TCM inheritance support system is of great practical value for minning the old doctors' clinical experiences.

Pulmonary Lipiodol Embolism after Transcatheter Chemoembolization for Hepatocellular Carcinoma / 결핵및호흡기질환

Pulmonary lipiodol embolism is a rare but very fatal complication of transcatheter arterial chemoembolization (TACE), Here we present the case of an unusual complication of TACE in a 67-year-old man who presented with dyspnea, hemoptysis, and a history of a third session of TACE for hepatocellular carcinoma (HCC) that had been performed 3 days prior to presenting. On the basis of chest X-ray and computed tomography (CT) scan findings, we diagnosed pulmonary lipiodol embolism. He was conservatively treated with oxygen and haemostatic agents. The patient recovered quickly without any significant sequela and was discharged.

Neumonía por Rhodoccocus equi en paciente con infección por el VIH. A propósito de un caso / Rhodococcus equi pulmonary infection in an HIV-infected patient and radiological worsening following treatment. Case report

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Differentiated Thyroid Carcinoma Presenting Distant Metastses as a Initial Sign

PURPOSE: Distant metastases, as the initial sign of a differentiated thyroid carcinoma, are extremely rare. The clinical characteristics for such cases remain to be established. This study was performed to characterize the clinical presentation, treatments, and outcome in such patients. METHODS: Between January 1986 and February 2005, of 4,525 differentiated thyroid cancer patients, 18 presented with distant metastases as the initial sign (0.4%). These comprised of 6 men and 12 women, with a median age of 49 years (range 9~66). Of the 18 patients, 8 (44.4%), 7 (38.9%), and 3 (16.7%) disclosed symptoms from lung, bone, and brain (16.7%) metastases, respectively. The median follow-up was 92 months, ranging from 18 to 198. RESULTS: The symptoms included cough and sputum (n=5), hemoptysis (n=2) and a lung mass (n=1) from lung metastases, back pain (n=3), a palpable mass (n=2) and a pathologic fracture (n=2) from bone metastases, as well as a headache with nausea (n=3) in all cases with brain metastases. The sites of metastases were the lung only in 7 (38.9%), bone only in 7 (38.9%) and multi-organ in 4 (22.2%). The histological diagnoses were a papillary carcinoma in 10 and a follicular carcinoma in 8. All patients underwent a total thyroidectomy followed by therapeutic radio-iodine therapy (RAI) and TSH suppressive treatment. For the metastatic lesions, aggressive treatment modalities, including surgical resection (n=9), external beam radiation (n=11), gamma-knife surgery (n=1) and a combination of these, were performed. The 10 year overall and disease-free survivals were 91.7 and 51.4%, respectively. There was only one disease-related death (1.6%). Tumor multiplicity (p=0.023) and multi-organ metastasis (p=0.009) were significant predictors of a poor prognosis. CONCLUSION: Clinical symptoms, history, physical examination, imaging studies and histological confirmation of distant metastatic lesions are important in the initial diagnostic approach. Even though distant metastasis presented as the initial sign, a 10-year disease-free survival rate of 50% was obtained. Radical resection of primary and metastatic lesions combined with high dose RAI treatment and/or external irradiation lead to long-term survival.

Exclusión endoprotésica de fístula aortobronquial con hemoptisis / Endoprosthetic exclusion of aortobronchial fistula with haemoptysis

Introducción. Describimos el uso de una técnica endovascular para la reparación de una fístula aortobronquial (FAB) originada en un pseudoaneurisma aórtico anastomótico secundario a múltiples cirugías aórticas para la reparación de un aneurisma de aorta torácica (AAT) descendente. Caso clínico. Varón de 51 años, ex fumador, bebedor con hepatopatía crónica y con limitación crónica al flujo aéreo, que presenta hemoptisis significativa por FAB secundaria a pseudoaneurisma tras múltiples intervenciones aórticas (reparación de AAT descendente, reparación de FAB secundaria y reparación de un pseudoaneurisma del arco aórtico, incluida la arteria subclavia izquierda, mediante la técnica de elephant trunk). El diagnóstico de FAB se realizó mediante tomografía computarizada (TC), angiorresonancia y angiografía de sustracción digital (ASD). El paciente se sometió a reparación endovascular mediante un abordaje ilíaco, debido al alto riesgo de una reparación convencional. Se colocó una endoprótesis vascular dentro de la prótesis de Dacron existente, y se cubrió el punto de fuga de la fístula. La ASD de comprobación en el quirófano mostró ausencia de fugas. Al paciente se le da de alta a los 5 días de la operación, sin complicaciones, con tratamiento antiagregante. En el control a los 2 años el paciente persiste clínicamente asintomático, y no se visualizan complicaciones en las TC de control. Conclusiones. Las FAB que se presentan a modo de hemoptisis graves son un proceso de evolución tórpida y fatal en muchos casos, de difícil manejo terapéutico, especialmente en aquellos casos con cirugía previa. El abordaje endovascular es una alternativa útil en estos casos, y disminuye la morbimortalidad de la cirugía abierta convencional (AU)

Leptospirosis hemorrágica pulmonar / Hemorrhagic pulmonary leptospirosis

La leptospirosis es una enfermedad infecciosa característica de países orientales húmedos. La incidencia en países occidentales es relativamente infrecuente. La enfermedad suele manifestarse de dos formas clínicas principales: la hepato-renal y la pulmonar, generalmente con cierto grado de solapamiento entre ambas.Presentamos un paciente con una presentación severa de leptospirosis hemorrágica pulmonar que en el curso de la enfermedad, presentó un cuadro de embolismo multisistémico (bazo, riñón y sistema nervioso central -SNC-). (AU)

A case of microscopic polyangiitis combined with pulmonary silicosis / 대한내과학회지

Microscopic polyangiitis (MPA) is a distinct type of systemic small vessel vasculitis affecting small sized vessels with few or no immune deposit and no granulomatous inflammation. Cause or pathogenetic mechanism of MPA has been unknown but association with silicon or silica exposure or pulmonary silicosis has been reported rarely and supports hypothesis that environmental factors are important modulating or triggering factors of the vasculitis in the indivisual who may be genetically predisposed. We report a case of microscopic polyangiitis with underlying pulmonary silicosis in 43 year-old male. He was admitted due to hemoptysis, dyspnea, fever and bilateral pulmonary infiltration with underlying small nodular densities in whole lung field and egg-shell calcification of both hilar areas. Laboratory findings showed hematuria, proteinuria and rapid deterioration of renal function. Renal biopsy revealed focal segmental necrotizing glomerulonephritis with early cellular crescents accompanied with membranous glomerulonephropathy and perinuclear-antineutrophil cytoplasmic antibody was positive. Under the diagnosis of MPA, he has been managed with high dose steroid, cyclophosphamide and hemodialysis. Chest infiltration decreased and hemoptysis and hypoxia was improved but renal function was not recoverd and he needed regular hemodialysis continuously.

A Case of Tracheal Papillomas Treated With Bronchofibroscopic Nd-YAG Laser Therapy / 결핵

In contrast to juvenile laryngeal papillomatosis, which occurs most often in children and teenagers and is usually self limited, soliatry papilomas in adults are one of uncommon tumors of airway, and have a higher incidence of cancer. They are caused by the respiratory infection of human papilloma virus(HPV). They culd spread to more distal airways and have a tendency of recurrence after limited surgical excision. Recently endoscopic therapies such as Nd-YAG laser, electrocautery, and cryotherapy provide extremely effective treatment modalities. We report a case of solitary tracheal papillomas in a 48 year-old man who presented with cough, scanty hemoptysis, and functional evidence of central airway obstruction. He was successfully treated by a Nd-TAG laser therapy via fiberoptic bronchoscopy under the local anesthesia.

Ação da radioterapia em sintomas torácicos específicos produzidos por neoplasias pulmonares / Effects of radiotherapy on thoracic symptoms due to pulmonary neoplasms

Foram analisados no presente estudo 172 pacientes com neoplasia maligna de pulmão, tratados com radioterapia exclusiva, no período de janeiro de 1972 a maio de 1993 e que apresentaram sintomas torácicos específicos relacionados à enfermidade, a saber: 29 pacientes apresentaram hemoptise (16,8 por cento); 50 pacientes apresentaram dor torácica (29,06 por cento), 52 pacientes apresentaram disfonia conseqüente à lesão do nervo recorrente (30,2 por cento) e 41 pacientes apresentaram síndrome de veia cava superior (23,8 por cento). Os pacientes foram tratados em acelerador linear de 4 Mev, com campos torácicos, nos seguintes esquemas terapêuticos: a) dose igual ou inferior a 2.000 cGy, b) doses de 2.000 a 5.000 cGy, c) doses superiorres a 5.000 cGy. Avaliou-se em cada grupo os índices de melhoria objetiva e subjetiva apresentados no final do tratamento. O índice global de melhora subjetiva foi de 54,8 por cento, e de melhora objetiva de 30,6 por cento, sendo ambos os índices mais elevados nos pacientes que apresentaram hemoptise e dor torácica (respectivamente 65,5 por cento e 62 por cento para melhora subjetiva; 41,3 por cento e 32 por cento para melhora objetiva). Nos 4 grupos de pacientes, os que apresentaram melhora objetiva ou melhora subjetiva apresentaram índices de sobrevida significativamente superiores (p<0,001). A radioterapia torácica revelou-se no presente estudo um tratamento prático e eficaz na melhora dos sintomas causados pelas neoplasias pulmonares avançadas, podendo produzir significativo incremento na qualidade de vida e na sobrevida dos pacientes que apresentaram resposta clínica.

Hidatidosis pulmonar: experiencia en 594 pacientes y 830 quistes (1964-1990) / Pulmonary hydatidosis: experience in 594 patients and 830 cysts (1964-1990)

Se presenta la experiencia acumulada entre los años 1964 y 1990 representada por 594 pacientes portadores de 830 Quistes Hidatídicos Pulmonares (QHP), de los cuales 12,7 era asintomático y 3,8 por ciento presentaron hemoptisis masiva. El arco 5§ de Caprón tiene una sensibilidad sñolo del 53,6 por ciento siendo algo amyor en los quistes complicados, sin embargo la inmunoglobulina E total sérica es patológica en 85,5 por ciento de positividad y en 93 por ciento de los casos con QHP complicado. El 50 por ciento de los quistes se encuentran en lóbulos inferiores y en 24,6 por ciento de los casos existe una localización extrapulmonar asociada. Quistes únicos 80 por ciento de los casos. QHP múltiples 18,8 por ciento de los casos que 60,9 por ciento comprometen ambos pulmones. Al acto quirúrgico 45,6 por ciento de los QHP estaban complicados, además existen 43 casos (14,3 por ciento ) de tránsito hepatotorácico y 40 (13,3 por ciento ) de migraciones pleurales. Tratamiento quirúrgico: quistectomía en 536 QHP (60,4 por ciento ), resección pulmonar en 285 (32,1) (segmentectomía 10,4 por ciento , lobectomía 84,3 por ciento y neumonectomía 5,5 por ciento ) y otros procedimientos en 66 quistes (7,5 por ciento ). Entre las complicaciones (12,8 por ciento ) la fistula broncopleural se presenta en 3,5 por ciento de las resecciones efectuadas y la mortalidad es de 2,3 por ciento