Role of computed tomography angiography in the evaluation of haemoptysis in children: Decoding the abnormal vessels

Background & objectives: Haemoptysis in children is potentially life-threatening. In most cases, the bleeding arises from the systemic circulation, and in 5-10 per cent of cases, it arises from the pulmonary circulation. The role of computed tomography angiography (CTA) in this setting is important. This study was undertaken (i) to study the role of single-phase split-bolus dual energy contrast-enhanced multidetector row CTA (DECTA) in the evaluation of haemoptysis in children; (ii) to analyze the patterns of abnormal vascular supply in the various aetiologies encountered. Methods: A retrospective study of 86 patients who underwent split bolus DECTA for the evaluation of haemoptysis was performed. Final diagnoses were categorized as normal computed tomography, active tuberculosis (TB), post-infectious sequelae, non-TB active infection, cystic fibrosis (CF), non-CF bronchiectasis, congenital heart disease (CHD), interstitial lung disease, vasculitis, pulmonary thromboembolism and idiopathic pulmonary haemosiderosis. Abnormal bronchial arteries (BAs) and non-bronchial systemic collateral arteries (NBSCs) were assessed for number and site and their correlation with underlying aetiologies. Results: A total of 86 patients (45 males, age from 0.3 to 18 yr, mean 13.88 yr) were included in the study; among these only two patients were less than five years of age. The most common cause of haemoptysis was active infection (n=30), followed by bronchiectasis (n=18), post-infectious sequelae (n=17) and CHD (n=7). One hundred and sixty five abnormal arteries were identified (108 BA and 57 NBSC), and were more marked in bronchiectasis group. Interpretation & conclusions: Active infections and bronchiectasis are the most common causes of haemoptysis in children. While post-infectious sequelae are less common, in patients with haemoptysis, the presence of any abnormal arteries correlates with a more frequent diagnosis of bronchiectasis. NBSCs are more common in post-infectious sequelae and CHD

Accidental aspiration of endodontic file: a dreaded but a preventable complication

Accidental ingestion of dental objects has been reported previously in literature. Accidental aspiration of a dental object is however uncommon. The affected patient may exhibit varying range of symptoms depending on location, type, shape and size of the foreign body swallowed/aspirated. We report a case about successful retrieval of an aspirated endodontic file with special focus on risk factors, prevention and management of these iatrogenic complications.

Severe haemoptysis in a 5 year old child with Kartagener's syndrome: case report

Kartagener`s syndrome, a rare autosomal recessive disorder is a type of Primary Ciliary Dyskinesia (PCD) associated situs inversus, bronchiectasis, sinusitis and male infertility. We present a case of a 5-year-old girl who came with features of bilateral glue ear, recurrent sinusitis, recurrent hemoptysis and dextrocardia. She was diagnosed to have Kartagener`s syndrome and was evaluated for recurrent hemoptysis.

Nódulo pulmonar cavitado en artritis reumatóide: reporte de un caso / Cavitating pulmonary nodule in rheumatoid arthritis: A case report

RESUMEN Los nódulos reumatoides pulmonares son una manifestación extra-articular infrecuente de la artritis reumatoide (AR). Su estudio es importante porque su presentación clínica e imagenológica puede confundirse con tuberculosis, infecciones fúngicas y neoplasias pulmonares. Producen pocos síntomas y pueden conducir a complicaciones fatales como neumotórax, fístula broncopleural y sobreinfección con formación de abscesos. La confirmación diagnóstica fundamental descansa en el estudio histopatológico, dado que es un diagnóstico de exclusión. El tratamiento precisa seguimiento clínico ya que no hay una terapia dirigida utilizándose en casos severos rituximab y tocilizumab. En general, su aparición tiende a empobrecer el pronóstico de los pacientes con AR.

ABSTRACT Pulmonary rheumatoid nodules are an uncommon extra-articular manifestation of rheumatoid arthritis (RA). Its study is important because the clinical and imaging presentation could be confused with tuberculosis, fungal infections, and/or lung neoplasms. Pulmonary nodules produce few symptoms and can lead to fatal complications such as pneumothorax, bronchopleural fistula, and a superinfection with abscess formation. The fundamental diagnostic confirmation is the histopathological study because it is an exclusion diagnosis. The treatment needs clinical follow-up as there is no targeted therapy, with Rituximab and Tocilizumab being used in severe cases. In general, their appearance tends to lead to a poorer prognosis of patients with RA.

A simplified approach to haemoptysis

Haemoptysis is commonly seen in the healthcare setting. It can lead to life-threatening complications and therefore requires careful evaluation of the severity and status of the patient. Common causes of haemoptysis can be broadly grouped into five main categories: infective, neoplastic, vascular, autoimmune and drug-related. Detailed history-taking and careful physical examination are necessary to provide a diagnosis and assess the patient's haemodynamic status. Physicians must have a clear understanding of the criteria for further investigations and the need for a specialist or inpatient referral for management.

Risk factors of massive hemoptysis in tuberculosis patients / 实用医学杂志

Objective To explore the risk factors for patients with massive hemoptysis in tuberculosis and to provide a strategy for clinical treatment for tuberculosis massive hemoptysis (TMH). Methods Chi-square test and multivariate logistics analysis were applied to analyze the medical data of 241 cases of TMH. Results Chi-squared test showed that eleven factors were found to be significantly correlated with TMH. Longer disease course (≥3 months), lung lesions range ≥ 3 lung fields, pulmonary tuberculosis cavity, a higher smoking index (≥400 cigarettes per year) and clinical treatment were risk factors for TMH. Patients aged 45 years or older accompanied with bronchiectasia, pulmonary fungal infection, diabetes or hepatopathy had higher probabilities of developing massive hemoptysis. Multivariate analysis showed lung lesions range over 3 lung fields (OR = 2.447,P = 0.015), pulmonary tuberculosis cavity (OR = 2.486, P = 0.004), bronchial asthma (OR =3.192,P = 0.002), pulmonary fungal infection (OR = 3.896, P = 0.005) and hepatopathy (OR = 3.101, P =0.006) were final risk factors for TMH. Conclusion Multiple factors contributed to patients with massive hemoptysis in tuberculosis. Lung lesions range over 3 lung fields, pulmonary tuberculous cavities, bronchial asthma, lung fungal infection and hepatopathy might be the independent risk factors for TMH.

Role of fibreoptic bronchoscopy in haemoptysis: an analysis of 157 patients.

Background: Objectives of this study were to define the role of fibreoptic bronchoscopy (FOB) in determining the etiology of haemoptysis, to determine whether bronchoscopy is useful in haemoptysis with normal chest x-ray, to determine whether early bronchoscopy is better than delayed bronchoscopy. Methods: This prospective study was conducted on 157 patients who presented with hemoptysis to the Department of Tuberculosis and Chest diseases. All these patients underwent FOB after taking proper history and examination and ruling out any contraindication to the procedure. Results: In patients with haemoptysis with normal CXR, a diagnosis was established in 54.5% by FOB while 38.6% had a normal bronchoscopy. An endoscopic diagnosis of bronchitis was made in 22.7% patients. In only 9.1% patients an endobronchial mass was seen on bronchoscopy, and all of them were more than 40 years of age. Active bleeding/bleeding site was localized in 18.1% patients. In patients with abnormal chest roentgenogram who underwent FOB, a definitive diagnosis was established in 75.4% cases with active bleeding/ bleeding site localized in 59.6%. Thirty five percent were having an endobronchial mass. Of all the patients who underwent FOB for recurrent haemoptysis, active bleeding/bleeding site was localized in 48.4% patients. Bleeding site was localized in 62.9% patients who underwent early FOB, while the yield was lower (29.4%) in patients who underwent delayed FOB. Conclusions: Fibreoptic bronchoscopy (FOB) is an important and useful investigation in patients of haemoptysis in determining the bleeding site and etiology of haemoptysis. Early FOB has higher yield in localizing the bleeding site than delayed FOB.

Pharmacognostical, Phytochemical and Pharmacological Overview: Cissus quadrangularis Linn.

Cissus quadrangularis (Linn) has been used by the common man in India, and neighboring countries, Pakistan, Sri Lanka, Malaysia for promotion of fracture healing and well known as “Hadjod”. It is also known as Vitis quadrangularis Wall. belongs to family Vitaceae. It is a common perennial climber, which is distributed throughout India, particularly in tropical regions. It requires warm tropical climate and propagated by stem cuttings. The plant is prescribed in the ancient Ayurvedic literature as a general tonic and analgesic, with specific bone fracture healing properties. The plant is believed to be useful in helminthiasis, anorexia, dyspepsia, colic, flatulence, skin diseases, leprosy, hemorrhage, epilepsy, convulsion, haemoptysis, tumors, chronic ulcers, swellings. The scrutiny of the present overview revealed pharmacognostical, phytochemical and some notable pharmacological activities of the plant such as Anti-osteoporotic activity, antioxidant, free radical scavenging, antimicrobial, antibacterial, bone healing, anti ulcer, analgesic and anti inflammatory, diuretic, Anabolic and Androgenic activity and toxicity studies.

Isolated Endobronchial Capillary Haemangioma: A Rare Cause of Haemoptysis in Adult.

Endobronchial capillary haemangioma is a very rare benign tumour in adults. The clinical presentation and management of adult capillary haemangiomas involving the tracheo-bronchial tree is not yet established. We present a case of an isolated capillary haemangioma of the left main bronchus detected during the evaluation of an adult male presented with haemoptysis. The lesion was managed successfully bronchoscopically.

Ausencia unilateral de una arteria pulmonar en el adulto / Unilateral Absence of the Pulmonary Artery in an Adult

La agenesia de la arteria pulmonar unilateral (UAPA) generalmente está asociada a otros defectos cardiovasculares congénitos cuando se diagnostica en la niñez. La ausencia asilada es una entidad rara y usualmente detectada en el adulto, con síntomas inespecíficos e incluso asintomáticos que dan lugar a un retraso en el diagnóstico y tratamiento. Nosotros reportamos el caso de una mujer de 40 años de edad con agenesia de la arteria pulmonar izquierda diagnosticada en el puerperio inmediato al debutar con hemoptisis. La radiografía de tórax muestra signos de congestión e hipertensión pulmonar. La angiotomografía de tórax revela la ausencia de la arteria pulmonar izquierda. Los médicos deberíamos considerar la posibilidad de UAPA no diagnosticada en adultos a través de una radiografía que sugiera el diagnóstico y confirmarlo con una angiotomografía de tórax.

Unilateral absence of the pulmonary artery (UAPA) is usually associated with other congenital cardiovascular defects when it is diagnosed in childhood. Its isolated absence is a rare entity that is usually detected in the adult; the clinical picture may be nonspecific and even asymptomatic leading to delays in diagnosis and treatment. We report the case of a 40 year old female with absence of the left pulmonary artery diagnosed in the immediate postpartum period because she had hemoptysis. The chest radiography showed signs of congestion and pulmonary hypertension. The angiography of the chest revealed the absence of the left pulmonary artery. Physicians should consider the possibility of undiagnosed UAPA in adults through a chest radiography that suggests the diagnosis. Confirmation can be established by CT angiography.

Thoracic endometriosis with catamenial haemoptysis and pneumothorax: computed tomography findings and long-term follow-up after danazol treatment

Thoracic endometriosis (TE) is an uncommon disorder affecting women of childbearing age. We herein report clinical and thin-section computed tomography (CT) findings of two cases, in which one woman presented with catamenial haemoptysis (CH) alone and another woman presented with bilateral catamenial pneumothoraces (CP) coinciding with CH, a rare manifestation of TE. The dynamic changes demonstrated on thin-section chest CT performed during and after menses led to accurate localisation and presumptive diagnosis of TE in both patients. Following danazol treatment, the patient with CH alone had a complete cure, while the patient with CP and CH had an incomplete cure and required long-term danazol treatment. We discuss the role of imaging studies in TE, with an emphasis on the appropriate timing and scanning technique of chest CT in women presenting with CH, potential mechanisms, treatment and patient outcomes.

Testicular embryonal cell carcinoma presenting as haemoptysis and skin nodules.

Embryonal cell carcinoma affects young males in the prime of their life with majority of tumours already having metastasised at the time of diagnosis. Subcutaneous metastasis from embryonal carcinoma is rare and is associated with widespread disease and poor prognosis. We report a case of 22-year-old male who presented with haemoptysis and skin nodules. Fine needle aspiration cytology of skin nodules and the lung lesion led to the diognosis of testicular embryonal cell carcinoma.

hair an unusual foreign body in airways presenting with haemoptysis in an adult patient.

Haemoptysis is defined as expectoration of blood originating from the lungs or tracheo-bronchial tree. It is attributed to various causes like tuberculosis, bronchiectasis, lung cancer, mycetoma, foreign bodies etc. Various types of foreign bodies have been reported in the literature. We report the case of an adult female patient who presented with an episode of haemoptysis (150 mL) in whom flexible fibreoptic bronchoscopy revealed a single long hair at the carina going to left main bronchus. Following successful removal of this hair there were no further episodes of haemoptysis and the patient manifested clinical and radiological improvement.

Isolated right pulmonary artery agenesis with agenesis of right upper lobe and bronchiectasis of right lower lobe with anomalous arterial supply from celiac axis with normal venous drainage.

Isolated unilateral absence of pulmonary artery (UAPA) is a rare congenital anomaly. When detected in infancy, the condition is commonly associated with cardiovascular defects which are more frequently associated with left pulmonary artery agenesis. Patients with isolated right pulmonary artery agenesis survive into adulthood with minimal or no symptoms and are diagnosed incidentally on the chest radiographs. We report a case of a 19-year-old female patient who presented to us with recurrent haemoptysis. She was symptomatic since the age of four years. We report the rare occurrence of UAPA on right side, agenesis of right upper lobe and bronchiectasis of right lower lobe with anomalous arterial supply of right lung from coeliac axis in this patient.

Meta analysis of efficacy and safety of levofloxacin in treatment of refractory pulmonary tuberculosis hemoptysis / 中国生化药物杂志

Objective To study efficacy and safety of the levofloxacin in treatment of refractory pulmonary tuberculosis hemoptysis by meta analysis.Methods Pubmed (2000/2014-07),EMbase (2000/2014-07),the Cochrane library (2014,7),the Chinese biomedical literature database (2000/2014-07)were retrieved about the randomized controlled trials of levofloxacin in treatment of refractory pulmonary tuberculosis hemoptysis,and the time was limited from January 2000 to July 2014.After objective evaluation of the retrieved paper quality,Cochrane collaboration with Rev Man 5. 3 software system was applicated to Meta analysis.Results In six reports of the sputum negative rate,levofloxacin group was significantly higher,and the difference was statistically significant (OR=4.21,95%CI:3.08 ~5.75,P<0.0001);adverse reactions in three articles,the difference of adverse reactions incidence had no statistical significance (OR =0.82,95%CI:0.56 ~1.18,P =0.28)between experimental group and control group, respectively.Conclusion The clinical effect of levofloxacin in treatment of refractory pulmonary tuberculosis hemoptysis is significant with a high security, which gives a guidance for clinical treatment and is worth clinical promotion.

Congenital pulmonary vein atresia / 中华实用儿科临床杂志

Congenital pulmonary vein atresia (PVA) is a rare anomaly in clinic.Patients with congenital PVA are usually symptomatic and present with recurrent episodes of pneumonia or haemoptysis in infancy or childhood.Because PVA often occurs in the setting of other congenital heart lesions,so repeated infection of lung might be considered to associate with left-to-right intracardiac shunt with increased pulmonary blood,but ignore further examination of more rare cause.Diagnosis of PVA is based primarily on imaging test,chest radiograph,lung CT and fiberoptic bronchoscopy might reveal some indirect characteristic changes of the disease.Three dimensional contrast enhanced cardiac CT can make a definite diagnosis.The disease is difficult to cure at present,the aim of the treatment is to preserve lung function.The prognosis is associated with the number of involved pulmonary veins.

Haemoptysis after four years of lobectomy for aspergilloma.

We present a case of a 26-year-old male who underwent lobectomy for life-threatening haemoptysis due to aspergilloma in an old tuberculosis left upper lobe cavity who presented with recurrence of haemoptysis four years after the surgery. Fibreoptic bronchoscopy revealed Aspergillus colonisation in the ectatic residual bronchus which is an uncommon complication of lobectomy. The patient was successfully managed with antifungal agents.

Complicações em pacientes com fibrose cística / Complication of cystic fibrosis

A Fibrose Cística é uma doença genética, complexa, que compromete principalmente os aparelhos respiratório e digestivo. O diagnóstico precoce e o avanço das estratégias terapêuticas têm levado a um marcado aumento da sobrevida; no entanto, as complicações respiratórias e digestivas têm contribuído significativamente para importante morbimortalidade especialmente nos pacientes adultos. A progressão da doença respiratória pode causar complicações tais como hemoptise, pneumotórax e reações de hipersensibilidade pela colonização da via aérea por fungos. A doença gastrintestinal pode também ser complicada pela síndrome da obstrução intestinal distal.

Cystic Fibrosis is a complex genetic disease that damages especially the respiratory and the digestive systems. An early diagnosis and the advances in therapeutic strategies have led to a remarkable increase in survival rates. However, respiratory and digestive complications still contribute significantly to important mortality, especially in adult patients. The progress of respiratory disease may result in complications such as hemoptysis, pneumothorax and hypersensibility reactions due to fungi colonization of the airways. The gastrintestinal disease has also led to complications such as the distal intestinal obstruction disease.

Tracheopathia osteoplastica presenting with haemoptysis in a young male.

A young man presented with infrequent haemoptysis spanning over 10 years. Chest radiograph was normal. However, the computed tomography (CT) of the chest had shown endotracheal wall changes. The diagnosis of tracheopathia osteoplastica was suggested on fiberoptic bronchoscopy and confirmed histologically.

Recurrent haemoptysis following sildenafil administration.

Sildenafil is widely used in the treatment of male erectile disorder and is generally well-tolerated. Its adverse effects are reported to be mild and include flushing, headache, dyspepsia and visual disturbances. We document a case of recurrent haemoptysis observed soon after self administration of sildenafil in a 38-year-old male with no other causative factors. The episodes of haemoptysis stopped following stoppage of sildenafil.