Bronchial haemangioma: exceptionally rare cause of haemoptysis.

Bronchial haemangioma is an exceptionally rare cause of haemoptysis in the adult. There are currently less than 10 recorded cases in the literature. Airway haemangiomas are generally seen in infants with coexistent cutaneous haemangiomas. The incidence of bronchial haemangioma in adults remains unknown. This case reports the diagnosis and treatment of a bronchial haemangioma in a 56 year-old male presenting with a one-month history of haemoptysis. Bronchial haemangioma diagnosis was confirmed and excision performed by bronchoscopy without complication. Bronchial haemangioma should be a considered differential diagnosis in the presence of meaningful haemoptysis when an endoluminal lesion is visualised on computed tomography scan. This case also demonstrates that bronchial haemangiomas can be successfully removed via bronchoscopy with minimal risk and discomfort to the patient.

Radiological predictors of recurrent primary spontaneous pneumothorax following non-surgical management.

BACKGROUND: Studies to date have not identified any reliable predictors for recurrence of primary spontaneous pneumothorax (PSP) on plain chest radiograph (CXR). The aim of this study was to assess whether abnormalities on CXR at first presentation of PSP can be used to predict recurrence of PSP. METHOD: The study included all patients admitted to The Canberra Hospital between 1998 and 2004. CXRs taken at initial presentation were reviewed retrospectively by an independent radiologist. Radiological abnormalities on CXR included: pleural thickening: blebs/bullae; pleural irregularities and pleural adhesions. RESULTS: One hundred patients were followed up for a mean duration of 57 months. The total rate of recurrence was 54%. Multivariate analysis found that the presence of an abnormality (irrespective of the type) increased the likelihood of recurrence and the risk of recurrence increased with each additional abnormality. Patients having one, two and three or more abnormalities were 3.0 (95% CI=2.09, 3.91, p=0.018), 5.3 (95% CI=4.47, 6.13, p<0.001) and 12.6 (95% CI=11.57, 13.63, p<0.001) times more likely to develop recurrence respectively. CONCLUSION: In view of these results we now offer surgical treatment at first presentation PSP in patients in whom we identify two or more radiological abnormalities on CXR.

Azygos vein aneurysm--a case for elective resection.

Azygos vein aneurysm is a rare differential diagnosis for a posterior mediastinal mass lesion. It is often an incidental finding in a routine chest radiograph. Most azygos vein aneurysms are secondary to conditions causing elevated flow or pressure in the azygos system, like cardiac failure or cirrhosis of the liver. In this group of patients, once diagnosis is established, no treatment is required. Even in the idiopathic azygos vein aneurysms, where no primary cause can be identified, the recommendation so far has been to continue to observe rather than elective excision, since complications are unknown. We present the report of a 73 year old man who underwent excision of an azygos vein aneurysm, which contained a large, free floating thrombus. There has been another reported case of this complication as well [Gomez M-A, Delhommais A, Presicci PF, Besson M, Roger R, Alison D. Partial thrombosis of an idiopathic azygos aneurysm. Br J Radiol 2004;77:342-43].(1) In view of this we feel that it is safer to resect an idiopathic azygos vein aneurysm electively to prevent the possibility of pulmonary embolism.