A 52-Year-Old Woman With Recurrent Hemoptysis (original) (raw)

A 78-Year-Old Man With Recurrent Hemoptysis and Persistent Pulmonary Nodule

Chest

A 78-year-old Chinese man presented in March 2019 with a 2-day history of small-volume hemoptysis. He did not report any associated chronic cough, sputum production, epistaxis, night sweats, unintentional weight loss, or fever. He was an exsmoker of 10 pack years. His medical history was significant for ischemic heart disease on aspirin, as well as hospitalizations in 2016 and 2017 for hemoptysis. The patient's evaluation for hemoptysis was only notable for a right middle lobe nodule on chest CT imaging and Klebsiella pneumoniae on sputum cultures, for which he was treated with antibiotics. CHEST 2020; 157(3):e79-e84 Physical Examination Findings The patient's temperature was 36.9 C, BP was 139/ 75 mm Hg, heart rate was 65 beats/min, and oxygen saturation was 99% on ambient air. He was not tachypneic, and breath sounds were vesicular bilaterally on auscultation. There were no lesions or blood stains noted on examination of the oropharynx and external nares. There was no cervical lymphadenopathy, and the rest of the systemic examination was unremarkable.

Massive hemoptysis, the etiology is aorto-bronchial fistula

Tuberkuloz ve Toraks, 2012

A 41-year-old man presented with massive hemoptysis. On physical examination, auscultation of the lung reveals inspiratory crackles, predominantly located in the lower posterior lung zones and auscultation of the heart reveals 2/6 systolic souffle in all of the cardiac zones. During the observation in emergency room, the patient's hemoglobin values decreased from 15.5 mg/dL to 11.7 mg/dL. Because of this reason, erytrocyte suspension transfusion had been processed. Bilateral diffuse infiltration could be seen in postero-anterior chest X-ray. In the computed tomography (CT) of thorax, there was bilateral parenchymal ground glass opacities and consolidations ( ). During bronchoscopy, active bleeding from bilateral bronchial system was observed. Since intraalveolar hemorrhage was considered at the patient, etiology oriented examinations were evaluated. Patient was extubated after the hemopthysis had been controlled and then, he was transferred to the chest diseases clinique from the intensive care unit. Both in bronchoscopic samples and sputum samples of the patient, there was no acid resistant bacterium in direct microbiological examination and cultures for acid resistant bacterium were negative. In the evaluation of the patient in terms of vasculitic syndromes; anti-nuclear antibody, anti-neutrophilic cytoplasmic antibody and ENA panel were detected and they were all negative. In the medical consultation made with cardiothoracic surgery, there was no additional suggestion. In the control bronchoscopy for hemorrhage, only a former bleeding focal point on the left main bronchi has been observed. During bronchoscopy; bronchial lavage, bronchoalveolar lavage (from the right middle lobe bronchi) and transbronchial biopsy samples were obtained. However, those samples weren't useful for a specific diagnosis. Three months later, in the control CT of thorax of the case, ground glass Figure 1. A representative slice from second computed tomography scan (ground glass opacities).

Bronchoscopic findings in hemitruncus

Thorax, 1988

A right pulmonary artery originating from the ascending aorta was first reported by Fraentzel in 1868.' Including our own, only six cases of this anomaly have been described in adults.' The condition is more often recognised early in life, because the large left to right shunt rapidly leads to biventricular failure.369 Patients living beyond infancy experience frequent respiratory complaints, such as dyspnoea on exertion, episodic wheezing, and frequent airway infections."' Later haemoptysis will overshadow these symptoms. Haemoptysis first occurred in the age range 15-23 years in the reported cases.2 It characteristically follows exertion and the expectorated blood varies from minor amounts to as much as 200 ml. The true nature ofthe cause of bleeding is usually not apparent from physical examination or review of standard chest radiographs. Adults with this malformation are thus likely to undergo bronchoscopy for recurrent haemoptysis. The importance of this is well illustrated by the following case.

A young smoker with hemoptysis

Lung India, 2013

A 35-year-old man presented with complaints of dry cough, right lower chest pain, and streaky hemoptysis off and on for duration of 3 months. There was no history of fever, anorexia, or weight loss. He was a smoker with smoking index of 5-6 per day for 5-6 years. The general and respiratory system examination was unremarkable. The routine hematological and biochemical investigations were within normal limits. Radiograph of the chest demonstrated presence of a well-defined opacity in right lower zone. A contrast-enhanced computed tomography (CT) was done followed by biopsy under CT guidance. Histopathology provided the diagnosis. QUESTIONS Q1: The serial radiographs of chest in posteroanterior projection are provided [Figure 1]. What are your findings on chest radiograph? What is this sign called? Q2: What are the findings on CT? [Figure 2] Q3: What is your probable diagnosis? Q4: What should be the next investigation? A young man presented with complaints of dry cough, right lower chest pain, and streaky hemoptysis for duration of 3 months. A nonresolving opacity on chest radiograph and mass-like consolidation on computed tomography (CT), led to biopsy of the mass under CT guidance. Histopathology provided the diagnosis. The radiological features were retrospectively evaluated.

A 21-Year Old Male with Hemoptysis and Central Chest Pain

International Journal of Infection, 2018

Introduction: The diagnosis of endobronchial tuberculosis (EBTB) remains a diagnostic challenge due to its protean clinical presentation and absence of radiographic findings in 20% of the cases. In this report, we described a case of EBTB in a man who was presented to the emergency department with chest pain and hemoptysis. Case Presentation: A 21-year-old man who was presented to the emergency department with a 3-day hemoptysis and central chest pain. His past medical history was not remarkable. Chest computed tomography and bronchoscopy were performed and the lesion was biopsied; EBTB was confirmed based on histologic and microbiological evidences. A daily regimen of four-drug antitubercular therapy (ATT) was initiated and the patient was discharged home to follow tuberculosis clinic monthly. During the last follow-up visit, the patient did not show any symptoms and the repetition of the physical examination was not remarkable. Investigations showed a negative smear sputum, normal chest X-ray, and Normal Respiratory Function test. Conclusions: EBTB is a variant form of tuberculosis infection with a nonspecific clinical presentation and often, undetectable AFB in sputum smears. The lesion can be detected early by chest computed tomography and bronchoscopy, and the prognosis is good if the disease is confirmed and treated early.

A 35-year-old man with dyspnea and hemoptysis

Tanaffos, 2012

A man in his thirties was admitted due to new onset dyspnea, right-sided pleuritic chest pain and non-massive hemoptysis since 4 days before admission. On arrival, he was febrile and tachypneic with normal blood pressure. Bibasilar decreased breath sounds and vocal vibration, prominently in the right lung, and 2cm difference in diameter of the left leg were the remarkable findings. Blunting of the right costophrenic angle was prominent on chest x-ray. Laboratory analysis revealed normal blood cell count, elevated erythrocyte sedimentation rate (125 mm/hr.) and positive quantitative D-Dimer. Blood biochemistry and coagulation profile and urinalysis were normal. Anticoagulant was initiated with presumptive diagnosis of pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT). Doppler ultrasonography (DUS) and pulmonary computed tomographic angiography (CTA) were performed. DUS was normal, but right sided pulmonary artery embolus was confirmed with CTA . Interestingly, DUS revealed DVT in the right popliteal artery. Echocardiography was normal. Despite anticoagulative therapy, dyspnea progressed and the patient's general condition deteriorated. Pleural fluid analysis showed lymphocyte dominant exudate. TANAFFOS A B Figure 2. Chest X-ray showed blunting of right costophrenic angle Figure 1. Computed tomography with intravenous contrast revealed filling defect of an embolus in the right division of pulmonary artery (white arrow), loculated pleural effusion (black arrow head) and air-bronchogram in the left lung

To assess the role fiberoptic bronchoscopy in the evaluation of hemoptysis

International Journal of Research in Medical Sciences, 2016

Background: To prospectively evaluate the efficiency of the fiberoptic bronchoscopy (FOB) examination in the evaluation of patients with hemoptysis. Methods: We prospectively reviewed 50 patients who underwent FOB for hemoptysis. There were 39 male and 11 female. The mean age was 46 years with a range from 21 to 83 years. The patients were divided between two groups on the basis of their chest roentograms (46% with normal and 54% with abnormal findings). Results: Hemoptysis in normal and abnormal chest roentograms was respectively attributed to bronchiectasis in 5 (21.7%) and 3 (11.1%) cases, bronchogenic carcinoma in 2 (8.6%) and 9 (33.3%) cases, bronchitis in 2 (8.6%) and 3 (11.1%) cases, tuberculosis in 2 (8.6%) and 5 (18.5%) cases, cryptogenic causes in 8 (34.7%) and 4 (14.8%) cases and pseudohemoptysis in 2 (8.6%) cases (bleeding from upper respiratory tract). Conclusions: Fob plays a pivotal role in the evaluation of hemoptysis. It was found that left upper lobe followed by right upper lobe was the site most consistent with the findings, with bronchogenic carcinoma being the most common non-infectious cause. Infectious etiology was the most common pathology behind hemoptysis and bronchiectasis was the most important risk factor.

Morphologic spectrum of undetermined causes of hemoptysis- a pathologistÂ’s role

Turkish Journal of Pathology, 2020

Objective: Hemoptysis is the expectoration of blood or blood-streaked sputum from the tracheobronchial tree. The etiology may derive from nonneoplastic conditions such as infections, chronic pulmonary diseases, and vasculitis or neoplastic causes. Sometimes a definitive cause for hemoptysis cannot be found after ample diagnostic workup. The role of biopsy in such cases is to help the clinician in arriving at the final diagnosis. Diffuse alveolar hemorrhage is the main histopathological finding in hemoptysis and it appears with diffuse chest infiltrates radiologically. Material and Method: A retrospective study of 2 years duration was conducted to identify the morphological spectrum of diseases presenting with hemoptysis. A total of 243 lung biopsies obtained by various methods were retrieved in this study period and 20 cases with hemoptysis of undetermined etiology were detected. Results: Based on imaging and histopathology findings, the etiological causes of hemoptysis were divided into hemoptysis with and without capillaritis or due to tumor/tumor-like lesions and due to miscellaneous conditions. The most common etiology was vasculitis followed by infections. Conclusion: Histopathology helps to detect the etiology, particularly in cases of hemoptysis due to non-immunologic causes. In immunologic cases, histopathological findings may support the diagnosis in correlation with the clinical/imaging features.