"Massive hemoptysis" and shock after fever and cough / 中国当代儿科杂志

A boy, aged 11 years, was admitted due to intermittent fever for 15 days, cough for 10 days, and "hemoptysis" for 7 days. The boy had fever and cough with left neck pain 15 days ago, and antibiotic treatment was effective. During the course of disease, the boy developed massive "hemoptysis" which caused shock. Fiberoptic bronchoscopy revealed a left pyriform sinus fistula with continuous bleeding. In combination with neck and vascular imaging examination results, the boy was diagnosed with internal jugular vein injury and thrombosis due to congenital pyriform sinus fistula infection and neck abscess. The boy was improved after treatment with temperature-controlled radiofrequency ablation for the closure of pyriform sinus fistula, and no recurrence was observed during the follow-up for one year and six months. No reports of massive hemorrhage and shock due to pyriform sinus fistula infection were found in the searched literature, and this article summarizes the clinical features, diagnosis, and treatment of this boy, so as to provide a reference for the early diagnosis of such disease and the prevention and treatment of its complications.

Aneurisma de Arteria Pulmonar como causa de muerte repentina: Reporte de un caso y revisión de literatura / Pulmonary Artery Aneurysm as a cause of sudden death: Case report and literature review

Resumen Objetivo: Correlacionar las generalidades de la etiología, patogenia, presentación clínica y métodos diagnósticos actuales disponibles para el aneurisma de arteria pulmonar con la muerte súbita o repentina de estos pacientes. Materiales y métodos: Se realizaron revisión del expediente clínico, análisis de la autopsia y revisión bibliográfica. Presentación de caso: Se presenta el caso de un masculino de 39 años con antecedente de hipertensión pulmonar que consultó por disnea súbita. Se abordó el caso como un tromboembolismo pulmonar. El paciente presentó una evolución clínica tórpida y falleció. La autopsia reveló un aneurisma de la arteria pulmonar. Conclusión: Los aneurismas de la arteria pulmonar son poco frecuentes. La presentación clínica es inespecífica. Los métodos diagnósticos más fiables son la sospecha clínica y los métodos de imagen, sin embargo siguen siendo motivo de muerte súbita y repentina; cuyo hallazgo es postmorten.

Abstract Objective: Correlate the generalities of etiology, pathogenesis, clinical presentation and current diagnostic methods available for pulmonary artery aneurysm with sudden death of these patients. Materials and methods: Review of medical record, autopsy analysis and scientific literature. Case presentation: A 39-year-old male with a history of pulmonary hypertension, who consulted for sudden dyspnea. The case was approached as a pulmonary thromboembolism. The patient presented bad clinical evolution and died. Autopsy revealed an aneurysm of the pulmonary artery. Conclusion: Aneurysms of the pulmonary artery are rare. The clinical presentation is nonspecific. The most reliable diagnostic methods are clinical suspicion and imaging methods, however they remain a cause of sudden death; whose finding is postmortem.

Metabolic Super Scan in 18F-FDG PET/CT Imaging

A 50-yr-old man presented with intermittent hemoptysis and was diagnosed small cell lung cancer. 18F-FDG PET/CT for staging demonstrated extensive hypermetabolic lesions throughout the skeleton and liver. Interestingly, skeletal muscles of limbs, mediastinum, bowel, and especially brain showed very low FDG uptake. Because of some characteristics in common with super scan on skeletal scintigraphy, this case could be considered as 'metabolic super scan'.

Massive life-threatening hemoptysis from pulmonary hydatid cysts: a 13 - year experience from an endemic area

Echinococcosis is a parasitic disease often seen in sheep and cattle raised in countries with unsanitary conditions. The disease is encountered endemically in northwest of Iran. Life-threatening hemoptysis due to a pulmonary hydatid cyst is a rare condition. This study assessed the prevalence and treatment of this condition. Materials and In a retrospective study, between 1993 and 2005, 520 patients with pulmonary hydatid cysts were operated at the Imam Khomeini Hospital in Tabriz, Iran. Ten [1.9%] cysts exhibited life-threatening hemoptysis [Group II]. The remaining 510 patients with pulmonary hydatid cyst were studied [Group I] and compared with group II. Ten patients were included in group II, with a mean follow - up of 2.5 years. Four [40%] cases were males and six [60%] were females. The age ranged between 8 and 46 [mean 27.90 +/- 13.86] years. The most common symptoms were cough [100%], massive hemoptysis [100%], respiratory distress [100%], and chest pain [90%]. The amount of hemoptysis was between 600 and 1400 ml [mean 840 +/- 249.66] a day. The origin of bleeding in six [60%] was from the cyst in the right lung and in four [40%] from the left lung. Bronchoscopy revealed the site of bleeding in all 10 patients, and the lobe in seven [70%]. Chest x-ray and CT scan showed patchy infiltration in one or both lungs and a ruptured hydatid cyst in eight cases. Lobectomy was the most frequent applied procedure [100%]. Two [20%] cases died due to blood aspiration and respiratory distress syndrome, one in the 3rd and the other in the 4th postoperative day. The postoperative hospital stay ranged between 7 and 25 [mean 11.30 +/- 6.56] days. Two and a half years follow-up of patients was good. There was no recurrence. There were significant differences between the two groups In terms of complications and mortality [X2 =102.39, df=1, p<0.0005] and [X2 = 5.82, df=1, p<0.16]. Massive life-threatening hemoptysis due to pulmonary hydatid cysts must be managed as an urgent clinical entity. It has serious symptoms, serious post-operative complications and a high mortality rate.

causes of death among patients with tuberculosis in Khuzestan, Iran

To assess the cause of death in tuberculosis patients. It is a retrospective descriptive study conducted in Khuzestan province in the south west of Iran, from 2002 to March 2006. Medical records of tuberculosis patients over the 5-year period were reviewed and death data were analyzed. Inclusion criteria were documented TB, diagnosed based on National Tuberculosis Program [NTP], extracted data were analyzed in SPSS11.5 system and by descriptive statistics. One hundred and twenty five deaths [3.15%] with mean age of 48.96 +/- 10.03 years were detected. The frequency rate for cigarette smoking, diabetes, chronic renal failure, MDR-TB, imprisonment, HIV infection and injection drug usage were 31.2%,16%, 6.4%,6.4%,22.4%,13.6% and 22.4%, respectively. Eighty four deaths [67.2%] were directly attributed to tuberculosis, among them overwhelming TB disease, haemoptysia, and MDR-TB accounted as the cause of death in 77.4%, 13.1%, 9.5% and 6.4% respectively. Forty one [32.8%] deaths were due to other medical problems, which included AIDS, cardiovascular diseases, bacterial super infection and cancers i.e. 21.9%, 19.5%, 17.1% and 12.2% respectively. This study showed that overwhelming TB disease, haemoptysis, cardiovascular diseases, bacterial super infection and cancers are the main cause of death. Smoking, imprisonment, injection drug usage and diabetes are frequent risk factors for TB mortality

Pulmonary zygomycosis in a diabetic patient.

We report a case of pulmonary zygomycosis in an adult male diabetic patient who presented with fever and altered sensorium initially and later developed streaky haemoptysis. Bronchoscopy showed picture of necrotizing pneumonia. Sputum was negative for fungal elements on admission but later bronchial wash and repeat sputum samples were positive by microscopy and culture showed growth of Rhizopus species. Immediately the patient was put on amphotericin B but had a bout of massive haemoptysis and succumbed. A high index of suspicion is needed for an early diagnosis and aggressive treatment of this infection in view of the high mortality rate.

Pulmonary actinomycosis presenting with prolonged fever and massive hemoptysis: a case report.

We present a rare case of pulmonary actinomycosis complicated with massive hemoptysis. The patient was a 41-year-old male farmer, who had experienced prolonged fever and off-and-on blood streaked sputum for 2 years. He was admitted to our hospital because of 3 days of massive hemoptysis. He had no underlying medical illnesses, but was a heavy smoker and an alcoholic. The chest radiograph revealed patchy alveolar infiltration of the right upper lobe, mimicing tuberculosis. Massive hemoptysis was not controlled using conservative treatment and anti-tuberculous drugs. Emergency right upper lobe lobectomy was needed to stop the bleeding. Histopathologic examination demonstrated aggregates of filamentous gram-positive organisms in characteristic "sulfur granules", indicating actinomycosis. The fever subsided after intravenous augmentin was given, followed by 6 months of oral amoxicillin. The patient is doing well and has had no recurrent hemoptysis.

Causa de hemoptisis en pacientes admitidos al Hospital Nacional Dos de Mayo / Cause of hemoptisis in patients admitted to National Hospital Two of May

Objetivo: Determinar la magnitud del problema, causas de hemoptisis, severidad, letalidad y proporción de hemoptisis criptogénica, los resultados son comparados con series nacionales y extranjeras. Diseño: estudio prospectivo, descriptivo, transversal. Lugar y fecha : Hospital Nacional Dos de Mayo. Lima - Perú. 1ro de noviembre de 1997 al 30 de abril de 1998. Pacientes: 185 pacientes mayores de 14 años y sin límite superior de edad, fueron hospitalizados en los servicios de Medicina Interna y Neumología con el diagnóstico de hemoptisis, además fueron incluidos los que ingresaron con otro diagnóstico pero en quienes la causa mayor de su hospitalizació fue la hemoptisis. Métodos: Se recolectaron datos mediante formulario de protocolo, se consolidaron tablas de frecuencia absoluta y relativa, se encontraron promedios, proporciones, mediana, moda, desviación estándar y riesgo relativo, aplicando el X² cuando fue necesario, se consideró signifcativo P<0.05 para el análisis de datos se utilizó el Software epi info 5.01. Resultados: el diagnóstico más frecuente fue Tuberculosis pulmonar (52.57 por ciento), Bronquiectasia (19.42 por ciento). Neumonía (5.14 por ciento), Cáncer (4.57 por ciento), Aspergiloma e hidatidosis pulmonar (4.00 por ciento) cada una de ellas). Otras causas menos frecuentes fueron: Estenosis mitral, quiste broncogénico y absceso pulmonar. La proporción de pacientes con hemoptisiscriptogénica fue 6.28 por ciento. Conclusiones: La Tuberculosis pulmonar es la causa más frecuente de hemoptisis en pacientes hospitalizados. Siendo la bronquiectasia la segunda causa mayor: La mayoría de los pacientes hospitalizados egresan con diagnóstico definitivo utilizando estudio broncofibroscópico y TAC pulmonar.

Hemoptise/s e sindrome de angústia respiratória do adulto como causa de morte na leptospirose. Mudanças dos padröes clínicos e anatomopatológicos: relato de caso / Haemoptysis and acute respiratory distress syndrome as causes of death in leptospirosis. Changes in clinical and anatomicophatological patterns

A leptospirose humana, uma das principais endemias/epidemias dos centros urbanos no Brasil, vem crescendo de forma dramática nas três últimas décadas, com prevalências após enchentes causadas pelas chuvas de veräo. Säo descritas as recentes modificaçöes de seus padröes clínicos em nossa regiäo, constituídas pelo surgimento de angústia respiratória do adulto, ou de ambas associadamente. Essas evidentes mudanças situadas nas estruturas respiratórias despontaram como séria ameaça à vida e como mecanismos de morte, passando a representar entre nós, por sua grande freqüência, a principal causa de óbito na leptospirose. A nova face da doença impöe revisäo dos conceitos sobre sua gravidade e especulaçäo sobre a patogenia dessas alteraçöes. A evoluçäo fatal dos seis pacientes descritos, dois deles sem icterícia e sem insuficiência renal, mostra a grandeza do desafio

Cryptogenic hemoptysis: role of fiberoptic bronchoscopy.

Fiberoptic bronchoscopy (FOB) was performed for recurrent hemoptysis in 79 patients with normal chest roentgenograms. Seventy per cent were females with a mean age of 31.93 years. Normal findings were obtained in 60 patients. In 19 patients with abnormal findings on bronchoscopy underlying malignant disease was discovered in 3 patients following bronchoscopy. All these patients were elderly male smokers. In three patients unexplained left recurrent laryngeal nerve palsy was discovered. Thus, FOB as a diagnostic aid for cryptogenic hemoptysis is useful only in elderly male smokers.

Abscesos primarios del pulmón / Primary lung abscess

Se presenta la experiencia recogida en el tratamiento de 23 pacientes con abscesos primarios del pulmón, asistidos entre los años 1965 y 1987. Se los analiza desde el punto de vista clínico, bacteriológico y terapéutico. Recibieron tratamiento médico 15 enfermos y médico-quirúrgico 8. Se efectuaron 7 neumonostomías y 2 lobectomías. La neumonostomía fue la operación de elección para aquellos pacientes que presentaban severo compromiso del estado general debido al cuadro toxinfeccioso; este procedimiento permitió la curación o al menos una mejoría ostensible. La lobectomía se indicó en la az crónica, constituyéndose en la resección de elección. La mortalidad en la presente serie fue de 4 casos, no imputables al absceso pulmonar