Safety and Efficacy Comparison of Embospheres and Gelfoam Particles in Bronchial Artery Embolization for Massive Hemoptysis.

Objective: The objective of this research study was to compare the safety and efficacy of bronchial artery embolization (BAE) using Embospheres alone versus Embospheres combined with gelfoam particles in patients with massive hemoptysis. Methods: A total of 127 patients with tuberculous massive hemoptysis who were scheduled to undergo BAE were recruited and divided into two groups: Embosphere group (E group, n = 57) and Embosphere combined with gelfoam particles group (E + G group, n = 70). Technical and clinical success were assessed after BAE surgery, and mortality, untoward reactions, and risk factors for clinical failure were recorded during follow-up. Results: The technical success rate was 92.99% in the E group and 97.14% in the E + G group (P = .272), with similar 1-year mortality rates of 1.76% and 2.86%, respectively (P = .684). However, the E group exhibited a lower clinical success rate compared to the E + G group (85.96% vs. 97.14%), and this difference was statistically significant (P = .020). The untoward reactions showed no statistically significant difference (all P > .05). Univariate analysis revealed that four factors were statistically significant: age (P = .028), presence of pulmonary cavity (P = .001), diabetes (P = .005), and a single use of Embosphere embolization (P = .020). Multivariate regression analysis demonstrated that embolization with Embosphere alone was a risk factor for clinical treatment failure (P = .025). Conclusion: The combination of Embosphere with gelfoam particles can significantly improve the hemostatic effect of BAE without increasing the incidence of adverse reactions.

Celiac disease and idiopathic pulmonary hemosiderosis: a literature review of the Lane-Hamilton syndrome.

Lane-Hamilton syndrome (LHS) presents a medical emergency, with 14% mortality due to Idiopathic Pulmonary Hemosiderosis (IPH) in acute phase. Despite the clinical severity of this entity, there has been no published review in the international literature, resulting in lack of awareness and delayed diagnosis.A rigorous search of international databases yielded a total of 80 LHS cases from January 1971 to August 2020. We analyzed 44 children (8.56 ± 4.72 years, 21 boys) and 36 adults (33.61 ± 13.41 years, 12 men) to present the clinical manifestations, radiological and immunological pattern, therapeutic approaches and outcome of LHS. We also elaborated on clinical and laboratory findings' associations to propose diagnostic indexes and clarified differences based on age distribution.Celiac disease (CD) and IPH diagnosis was made concurrently in 46 patients, whereas in 21 patients, the diagnosis of LHS was delayed for 2.5y (3 months-11 years). Hemoptysis (n = 56, 70%), dyspnea (n = 47, 58.8%), anemia (n = 72, 90%), and iron deficiency (n = 54, 67.5%) were most commonly observed. Medical history revealed recurrent episodes of hemoptysis (n = 38) and persistent iron deficiency anemia (n = 25) in need of multiple blood transfusions or iron supplementation. Patchy infiltrate opacities to consolidation predominated in children, whereas bilateral diffuse ground-glass opacities in adults. Duodenal biopsy was performed in 66 cases (diagnostic 87.8%), BAL in 51 (diagnostic 74.5%), and surgical lung biopsy in 20. Anti-tTG titer was positive in all 24 (54.6%) children and 19 (52.8%) adults that documented this assay. Prednisone or methylprednisolone pulse therapy and GFD were initiated in the acute phase, whereas chronic therapy included GFD, along with long-term prednisone in refractory cases. Three cases with severe respiratory failure or hemodynamic instability were intubated and a further three succumbed.A thorough understanding of LHS may reveal further diagnostic indexes and a consensus on therapy guidelines. Screening for CD is essential in all IPH cases for timely recognition and favorable outcome.

A life-threatening haemoptysis case that would have been defined as idiopathic before the COVID-19 era.

The coronavirus disease 2019 (COVID-19) is characterized by respiratory infection which can show very different clinical pictures, somewhat changing medical paradigm. Hemoptysis defined as idiopathic can be seen as much as 15%. Currently, increasing hemoptysis cases are being reported in medical coronavirus literature. We here present a hemoptysis case that would be defined as idiopathic before the COVID-19 era. After the first clinical picture, the case turned into a life-threatening hemoptysis. We studied the case comprehensively as clinical, pathogenetical, therapeutic and clinical practical aspects. Thus, we hypothesized that especially in the pandemic era, all hemoptysis cases must be evaluated as a possible life threatening infectious disease with unpredictable prognosis.

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.

The effect of ankaferd blood stopper used for massive haemoptysis in a patient with mounier-kuhn syndrome: A case report.

Mounier-Kuhn Syndrome (MKS) is a rare disorder derived from the muscular and elastic tissue defects of the trachea and the main bronchial walls, characterized by tracheobronchomegaly. Patients may present with complaints of cough, phlegm, dyspnoea and haemoptysis. Haemoptysis may be minor and mixed with phlegm or it may be massive. Establishment of airway patency is a priority in the management of massive haemoptysis. Cold saline solution, diluted adrenaline or tranexamic acid may be administered via the endobronchial route to stop haemorrhage while establishing the airway patency. Ankaferd Blood Stopper (ABS) has a haemostatic property and can be locally administered to the airway. In this report, we aim to highlight the effects of ABS administered via an endobronchial route for emergency palliation of a patient with MKS presenting with massive haemoptysis.

A Free Diver with Hemoptysis and Chest Pain.

[Full article available at http://rimed.org/rimedicaljournal-2019-02.asp].

A case of extensive pharyngeal vascular malformation successfully treated with Kampo medicine.

OBJECTIVE: To present the efficacy of Japanese-traditional medicine (Kampo) for a case with vascular malformation. METHODS: A case study and literature review. PATIENT: A 62-year-old female presented with dysphagia and spitting blood. Esophagogastroduodenoscopy showed a longitudinal lobulated and septated mass in the posterior pharynx. On MR imaging, the mass showed hyperintensity on T2-weighted images and heterogeneous enhancement on Gadlinium-enhanced T1-weighted images, suggestive of a low-flow vascular malformation. INTERVENTION: According to the Kampo diagnosis, kamisyouyousan and ninjinyoueito were prescribed to this patient. The effect of Kampo medicine was evaluated with improvement of her symptoms and volumetry of MRI findings. RESULT: The longitudinal pharyngeal mass was markedly decreased and her symptoms disappeared after 2 years of Kampo administration. CONCLUSIONS: Kampo medicine can be a novel alternative therapy for VM.

Acute Hypoxemic Respiratory Failure With Hemoptysis in a Dog Exposed to Copper Sulfate Powder.

A 2-year-old male mongrel dog was presented because of the onset of dry cough. About 16 hours before, the dog had been exposed to the pesticide that the owner was spraying in the vineyard. Approximately 3 hours later an acute respiratory failure, with a rapid evolution, began. Hemoptysis and regenerative normocytic normochromic anemia arose within hours, and a pulmonary hemorrhage was diagnosed. Pulmonary hemorrhage fast led to pneumonia, as evidenced by the serial CXR findings and the developing of leukocytosis. The hypothesis that we believe more likely is that the dog inhaled an amount of copper sulfate powder enough to determine respiratory tree damage, extending from the trachea to the pulmonary alveoli. Oxygen supplementation, antibiotics, antioxidant, and gastroprotective medications had been administered. After 4 days of hospitalization the dog was discharged. After a follow-up of more than 2 years later, the dog is still alive and in good health. To the authors knowledge no evidences of acute pulmonary involvement after copper sulfate inhalation exist in any species. This report is a contribution to the knowledge of copper poisoning, scarcely mentioned both in human and veterinary literature, and which has never been described in companion animals.

Acute hemoptysis and pulmonary hemorrhage after judo as presentation of intralobar sequestration.

Intralobar sequestration (ILS) is a rare anomaly that is usually diagnosed with symptoms of cough, expectoration, or recurrent pneumonia in children. We experienced a case of an 11-year-old boy with massive hemoptysis after judo sports. He was admitted to hospital and intubated due to respiratory failure. His chest computed tomography (CT) scan which was performed without contrast agent revealed a large intrapulmonary hematoma or tumor, mimicking traumatic hemothorax. Due to blood loss and circulatory instability, emergency thoracotomy was performed and a massive intralobar hemorrhage due to a ruptured ILS artery was found. After lobectomy including resection of the ILS, the patient was stabilized and extubated. Aspergillus was detected in the resected lobe and postoperatively acute respiratory distress syndrome (ARDS) and invasive aspergillosis occurred and was treated specifically. However, the young patient was discharged home 3 weeks later. In young patients with hemoptysis and intrapulmonary hemorrhage after trauma, the possibility of ruptured ILS should be kept in mind. This report shows that ILS can have a dramatic course of disease, and for this reason a nonurgent resection should be considered in all patients when this diagnosis is made.

Cytologic and histologic findings of iron pill-induced injury of the lower respiratory tract.

In the airways, iron pill-induced mucosal injury is uncommon and can lead to necrosis and stricture of the respiratory tracts. The process is characterized by mucosal ulceration with deposition of crystalline iron particles, and the diagnosis is usually made on tissue biopsies. We report a case of iron-sulfate-induced mucosal injury in the bronchial washing and biopsy of a patient receiving therapeutic oral iron supplementation with no known aspiration event. Clinically, the patient presented with hemoptysis, and bronchoscopy detected ulcerated main stem bronchus mucosa clinically suspicious for a neoplastic process. Bronchial washings revealed reactive epithelial cells and numerous histiocytes with both intracellular and extracellular refractile brown crystalline material, which was positive on iron stain. The histologic findings on biopsy showed mucosal ulceration with deposits of extracellular crystalline iron particles. These histologic changes are similar to those seen in iron pill-induced mucosal injury of the upper gastrointestinal tract in patients with "iron pill" gastritis. The cytologic and histologic features of iron pill-induced airway injury clinically can mimic cancer. The presence of extracellular and intracellular crystalline iron in the airway lumen and/or mucosa with associated varying degrees of ulceration and inflammation confirms the diagnosis.

How best to assess the quality of life in long-term survivors after surgery for NSCLC? Comparison between clinical predictors and questionnaire scores.

BACKGROUND: The determinants and predictors of QOL in lung cancer survivors who have received surgery remain defined vaguely and still debated. We evaluate clinical, surgical, and pulmonary function characteristics as predictors of QOL in long-term lung cancer survivors who received surgery. METHODS: Quality of life was evaluated 5 years after surgery in 67 lung cancer patients using the European Organization for Research and Treatment of Cancer (EORTC) QOL Core Questionnaire, its lung cancer-specific module QLQ LC-13, and the Hospital Anxiety and Depression Scale questionnaire. Preoperative clinical, surgical, and pathologic data were matched with the questionnaire scores. RESULTS: Sex was associated with role functioning and symptoms, with males more often reporting fatigue and pain, appetite loss, coughing, and hemoptysis (P < .05). Lower education was associated with better cognitive functioning (P < .05). Symptoms were worse for younger patients and for those with major comorbidity. Histology marginally influenced the global health status (P < .10) and the cognitive functioning (P < .05). Patients receiving complementary therapy more easily suffered from fatigue and insomnia (P < .05), and to a lesser extent from nausea and vomiting, constipation, and stress related to financial difficulties (P < .10). Higher values of forced expiratory volume at the first second (FEV(1)) and forced vital capacity (FVC) were significantly (P < .05) associated with a lower frequency of nausea and vomiting and appetite loss, while low percentage levels of FEV(1) and FVC were associated with lower global function and a greater severity of specific and nonspecific symptoms (P < .10 and P < .05). CONCLUSIONS: Several preoperative features, particularly those reflecting pulmonary function, were moderately associated with QOL in long-term survivors and may be useful to address therapeutic strategies in lung cancer patients after surgery.

Alveolar hemorrhage: distinct features of juvenile and adult onset systemic lupus erythematosus.

We compared outcomes of alveolar hemorrhage (AH) in juvenile (JSLE) and adult onset SLE (ASLE). From 263 JSLE and 1522 ASLE, the AH occurred in 13 (4.9%) and 15 (1.0%) patients, respectively (p < .001). Both groups had comparable disease duration (2.6 ± 3.0 vs. 5.6 ± 7.0 years, p = .151) and median SLEDAI scores [17.5 (2 to 32) vs. 17.5 (3 to 28), p = 1.000]. At AH onset, a higher frequency of JSLE were already on a high prednisone dose ( > 0.5 mg/kg/day) compared to ASLE (54% vs. 15%, p = .042). The mean drop of hemoglobin was significantly lower in JSLE (2.9 ± 0.9 vs. 5.5 ± 2.9 g/dL, p = .006). Although treatments with methylprednisolone, plasmapheresis, intravenous immunoglobulin and cyclophosphamide were similar in both groups (p > .050), regarding outcomes, there was a trend in high frequency of mechanical ventilation use (85% vs. 47%, p = .055) and also significant mortality (69% vs. 13%, p = .006) in JSLE compared to ASLE. The sepsis frequency was comparable in both groups (50% vs. 27%, p = .433). We have identified that AH in JSLE has a worse outcome most likely related to respiratory failure. The AH onset in JSLE already treated with high-dose steroids raises the concern of inadequate response to this treatment and reinforces the recommendation of early aggressive alternative therapies in this group of patients.

Pathologic evaluation of damage to bronchial artery, bronchial wall, and pulmonary parenchyma after bronchial artery embolization with N-butyl cyanoacrylate for massive hemoptysis.

Histologic evidence of safety after bronchial arterial embolization (BAE) with N-butyl cyanoacrylate (NBCA) should be assured. The present report describes a 78-year-old man with massive hemoptysis from lung cancer who underwent surgical lobectomy 23 days after hemostasis had been achieved via BAE with NBCA. Pathologic examination revealed that NBCA filled the lumen of bronchial branch arteries 143-1,094 µm in diameter from the lobar bronchus to subsegmental bronchus but was not seen in the lumen of the pulmonary artery or pulmonary vein. NBCA induced occlusion of bronchial branch arteries but no necrosis of the bronchial wall or pulmonary parenchyma.

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)