Hemoptisis secundaria a tuberculosis pulmonar complicada con pseudoaneurisma de Rasmussen. Reporte de un caso en pediatría. / Hemoptysis in Pulmonary Tuberculosis Complicated by Rasmussen's Pseudoaneurysm. A Pediatric Case Report.

Presentamos el caso de un niño de 12 años que consultó por hemoptisis, sin otros sín- tomas asociados. Se realizó radiografía de tórax (patológica), laboratorio con aumen- to moderado de reactantes de fase aguda, PPD (negativa), esputos x 3 con bacilosco- pias negativas y tomografía de tórax con contraste i.v. que mostró imágenes de árbol en brote en todos los lóbulos y una imagen de dilatación vascular de una rama de la ar- teria pulmonar en lóbulo superior izquierdo. Se plantearon diagnósticos diferenciales: malformación vascular primaria o lesión secundaria a infección. La angiografía digital permitió confirmar el pseudoaneurisma y embolizarlo. Luego de 17 días, 2/3 cultivos de esputo fueron positivos para Mycobacterium tuberculosis. El niño realizó tratamiento antituberculoso con drogas de primera línea con evolución clínica favorable. Este caso resalta la importancia de considerar el pseudoaneurisma de Rasmussen en- tre las posibles complicaciones de un paciente con tuberculosis y hemoptisis recurren- te o masiva.

We present the case of a 12-year-old boy admitted to the hospital due to hemoptysis without other symptoms. We performed a Thorax X-Ray (pathological), laboratory with elevated acute phase reactants, TST (negative), sputum x 3 with negative smear and computed tomography angiography showing a tree-in-bud pattern in all lobes, and di-latation of a brunch of the pulmonary artery in the upper left lobe. We considered pri-mary vascular anomaly or lesion due to infection as a differential diagnosis. The patient underwent digital angiography and therapeutic embolization of this pseudoaneurysm. After seventeen days, 2/3 of the sputum cultures were positive for Mycobacterium tu-berculosis. The patient received standard anti-TB therapy with favorable evolution. This case highlights the importance of considering complications such as Rasmussen's pseudoaneurysm in patients with pulmonary tuberculosis and recurrent or massive hemoptysis.

Case for diagnosis. Cutaneous small vessel vasculitis (anti-proteinase 3 positive), fever, hemoptysis, and lung cavitation in an adult

Abstract Small vessel vasculitis with anti-proteinase antibodies 3 is an atypical clinical presentation of tuberculosis. The authors present the case of a 47-year-old male patient, with palpable purpura and palmoplantar hemorrhagic blisters, with subsequent dissemination. He presented severe pulmonary symptoms with cavitation, fever, hemoptysis, and high levels of anti-proteinase 3. Histopathological assessment of the skin revealed small vessel vasculitis; pulmonary histopathology showed granulomas with caseation. Bronchoalveolar lavage was positive for alcohol-acid-fast bacilli. In countries with a high prevalence of tuberculosis, the presence of autoantibodies in a patient with vasculitis, fever, and pulmonary cavitation requires investigation of infectious causes.

Hemoptisis como signo de alarma de pseudoaneurisma de la aorta torácica: reporte de caso / Hemoptysis as a warning sign of thoracic aorta pseudoaneurysm: a case report

El pseudoaneurisma se define como un hematoma pulsátil repermeabilizado, encapsulado y en comunicación con la luz de un vaso dañado. Se origina cuando hay una disrupción de la pared arterial. La hemoptisis es un signo/síntoma de presentación muy rara de aneurisma aórtico torácico y de pseudoaneurisma aórtico torácico. Hay poca información sobre la hemoptisis asociada con la ruptura del aneurisma aórtico cuyo mecanismo no se explica por la presencia de una fístula aortopulmonar. Entre las hipótesis para explicar este fenómeno, se encuentra la capacidad de las arterias bronquiales de volverse hiperplásicas y tortuosas en presencia de una lesión que modifica la arquitectura pulmonar, siendo más susceptibles a la ruptura. También hay descripciones de lesiones directas del parénquima pulmonar por aneurisma roto. El presente caso nos ilustra que debemos considerar a la hemoptisis como signo de alarma en el diagnóstico diferencial de los aneurismas y pseudoaneurismas aórticos entre otras causas que puede ser fatal en breve tiempo por una hemorragia masiva.

Pseudoaneurysm is defined as a reperfused pulsatile hematoma, encapsulated and communicated with the damaged vessel's lumen. It originates when there is a disruption of the arterial wall. Hemoptysis is a very rare sign/symptom of a thoracic aortic aneurysm or pseudoaneurysm. There is little information on hemoptysis associated with aortic aneurysm rupture, whose mechanisms are not explained by the presence of an aortopulmonary fistula. Among the hypotheses to explain this phenomenon, is the ability of the bronchial arteries to become hyperplasic and tortuous in the presence of a lesion that modifies the pulmonary architecture, being more susceptible to rupture. There are also descriptions of direct lung parenchymal injury from ruptured aneurysm. The present case illustrates that we must consider the hemoptysis as a warning sign in differential diagnosis of aortic aneurysms and pseudo aneurysms, among other causes, that it can be fatal in a short time due to massive hemorrhage.

Hemoptisis recurrente asociada a falla renal y hematuria: otra de las mil caras de la enfermedad relacionada a IgG4 / IgG4 associated nephritis and recurrent hemoptysis: case report

IgG4 disease is a multi-systemic condition involving pancreas, salivary glands and lymph nodes. Less frequently, it causes interstitial nephritis and involves the lungs. We report a 58 years old male with a four years history of hemoptysis and renal dysfunction characterized by hematuria and proteinuria, responsive to steroidal therapy. The renal biopsy established the diagnosis of IgG4 associated interstitial nephritis. Lung involvement was considered secondary to the same systemic disease.

Diagnostic Yield of Bronchial Washing Fluid Analysis for Hemoptysis in Patients with Bronchiectasis

PURPOSE: Bronchiectasis is the main cause of hemoptysis. When patients with bronchiectasis develop hemoptysis, clinicians often perform bronchoscopy and bronchial washing to obtain samples for microbiological and cytological examinations. Bronchial washing fluids were analyzed from patients with bronchiectasis who developed hemoptysis, and the clinical impacts of these analyses were examined. MATERIALS AND METHODS: A retrospective observational study of patients who underwent fiberoptic bronchoscopy for hemoptysis in Seoul National University Bundang Hospital, a university affiliated tertiary referral hospital, between January 2006 and December 2010 were reviewed. Among them, patients who had bronchiectasis confirmed by computed tomography and had no definite cause of hemoptysis other than bronchiectasis were reviewed. The demographic characteristics, bronchoscopy findings, microbiological data, pathology results and clinical courses of these patients were retrospectively reviewed. RESULTS: A total of 130 patients were reviewed. Bacteria, non-tuberculous mycobacteria (NTM), and Mycobacterium tuberculosis were isolated from bronchial washing fluids of 29.5%, 21.3%, and 0.8% patients, respectively. Suspected causal bacteria were isolated only from bronchial washing fluid in 19 patients, but this analysis led to antibiotics change in only one patient. Of the 27 patients in whom NTM were isolated from bronchial washing fluid, none of these patients took anti-NTM medication during the median follow-up period of 505 days. Malignant cells were not identified in none of the patients. CONCLUSION: Bronchial washing is a useful method to identify microorganisms when patients with bronchiectasis develop hemoptysis. However, these results only minimally affect clinical decisions.

Hallazgos endoscópicos en pacientes con hemoptisis y radiografía de tórax normal / Endoscopics findings in patients with hemoptysis and normal chest X-ray

La hemoptisis se define como la emisión de sangre proveniente de la región subglótica, habitualmente por el mecanismo de la tos. Se realizó un estudio observacional descriptivo, de corte transversal y retrospectivo a los pacientes con hemoptisis y radiografía de tórax posteroanterior normal a los cuales se les realizó broncoscopia en el período de tiempo de enero de 1999 a enero del 2009 en el Hospital Neumológico "Benéfico Jurídico", con el objetivo de identificar los hallazgos endoscópicos obtenidos a través de este proceder. Se revisaron los libros de registros de broncoscopias y de los resultados de informes de Microbiología y Anatomía patológica del centro. La población estuvo compuesta por 197 enfermos y la muestra quedó constituida por 67 pacientes. El análisis estadístico se realizó en el programa EPIDAT versión 3.0. Se utilizaron medidas de resúmenes para variables cuantitativas, media y desviación estándar (DE), en todas las variables se usó la frecuencia absoluta y los porcentajes con sus respetivos intervalos de confianza del 95 por ciento. Predominó el sexo masculino con un total de 45 pacientes (67,2 por ciento) y el grupo de edad entre los 40-49 años. En 70,1 por ciento de los casos se observó signos inflamatorios, en 16 enfermos se obtuvo crecimiento de gérmenes patógenos y en 17 (25,3 por ciento) se confirmó el diagnóstico de enfermedad neoplásica por biopsia y/o cepillado bronquial.

Hemoptysis is defined as the outcomming of blood from the subglotic region, habitually by the mechanism of cough. A cross- sectional, retrospective, transverse and descriptive study was carried out in patients with hemoptysis and normal PA thorax's x-ray. To whom were practiced bronchoscopy in the "Benéfico Jurídico" Neumologyc Hospital from January 1999, to January 2009, with the purpose of identifing the endoscopyc discoveries obtained through this procedure. The information was obtained from the bronchoscopy, microbiology and pathological Anatomy records of this center. The population was composed by 197 sick people and the sample was constituted by 67 patients. The statistical analysis was carried out in the program EPIDAT version 3.0. Mediates and standard (SD) were used for quantitative variables and absolute frequency and the percentages with their respective intervals of trust of 95 percent were used in all the variables. The masculine sex prevailed with a total of 45 patients (67.2 percent) and the age group was among 40-49 years old. In 70.1 percent of the cases it was observed inflammatory signs, and it was also obtained growth of pathogenics germs in 16 patients and in 17 (25.3 percent) it was confirmed the diagnosis of neoplasic disease by biopsy and/or bronchial brushing.

Tratamiento endovascular con embolización Bronquial en pacientes con hemoptisis masiva / Bronchial embolization endovascular treatment in patients with massive hemoptysis

Antecedentes: La hemoptisis masiva constituye una emergencia médica con alta mortalidad. Objetivos: Informar la experiencia del tratamiento endovascular con embolización bronquial en una serie de pacientes consecutivos en una misma institución. Población: Se incluyeron prospectivamente entre 2001-2011 todos los pacientes con hemoptisis masiva que requirieron embolización bronquial. Método: Se registraron variables demográficas, clínicas y angiográficas. Se efectuó angiografía de arterias bronquiales y/o sitémicas provenientes de la aorta en todos los casos. La emolización fue realizada bajo contro radioscópico con micropartículas o microesferas calibradasentre 350-700 micrones. Cada procedimiento se dio por finalizado al comprobar la oclusión vascular de los territorios considerados responsables de la hemoptisis masiva. Se incluyeron 59 pacientes, edad 51 años, mujeres 29. Se realizaron 70 procedimiento de embolización (n=52 una única intervención y n= fueron necesarias dos o más intervenciones. Resultados: en 57/59 se observó éxito clínico inmediato, en 2/59 fue necesaria una segunda embolización dentro de las 72 horas para controlar la hemorragia. No hubo complicaciones mayores ni mortalidad relacionadas con el tratamiento endovascular. En el seguimiento mediano y largo plazo se observó recurrencia en 7/59 a los que se les repitió la embolización. Conclusión:El tratamiento endovascular fue seguro y efectivo en esta serie de pacientes, considerándose el método terapéutico inicial de elección en la hemoptisis masiva en nuestra institución.

Condrosarcoma de pulmón: reporte de un caso / Lung chondrosarcoma: report of a case

El condrosarcoma primitivo de pulmón es una neoplasia maligna de crecimiento lento y escasos síntomas respiratorios al inicio de la enfermedad. El objetivo de este trabajo es dar a conocer un tumor de pulmón poco frecuente, la evolución del mismo y la revisión de la literatura. El caso descrito en particular presenta disimilitudes con la literatura en cuanto a las manifestaciones clínicas, particularmente en el carácter de la tos y su causa, así como por la ausencia de hemoptisis. Por otra parte, el derrame pleural, solo se ha descrito en algunos casos de este tipo de tumor y el mismo es más frecuente en los tumores de estirpe epitelial. El condrosarcoma primario de pulmón, es una neoplasia que se diferencia por la histología y los estudios de inmunotinción, que por su historia natural amerita el diagnóstico oportuno para emplear la terapéutica que rinda los mejores beneficios y mejore la supervivencia.

The primitive lung chondrosarcoma is a malignant tumor of slow growth and low respiratory symptoms at the beginning of the course of the disease. The aim of this paper is to present a rare lung tumor, its evolution and the literature review. The case described in particular presents dissimilarities with the world literature regarding in the clinical manifestations, particularly in the character of the cough and its cause, and by the absence of the hemoptysis. Moreover, the pleural effusion, only been described in some cases of patients with this tumor type and the same is more common describe in the epithelial tumors. The primary chondrosarcoma of the lung is aneoplasm that is well differentiated by the histology and the immunohistochemistry studies, which by its the natural history warrants of the early diagnosis for the type of therapeutic uses, will render the best benefits and improvesurvival in the patients.

Tratamento endovascular de pseudoaneurisma de aorta torácica com fístula aorto-brônquica em pós-operatório tardio de cirurgia de correção de coarctação de aorta / Endovascular treatment of thoracic aortic pseudoaneurysm with aortobronchial fistula in the late postoperative period of surgical correction of the aortic coarctation

Fístula aorto-brônquica é uma conexão entre a aorta e o brônquio, e mesmo quando imediatamente reconhecida e tratada possui alto risco de letalidade. Pode se desenvolver após cirurgias de aorta, e é geralmente uma consequência de pseudoaneurisma. A hemoptise, massiva ou intermitente, é o principal sintoma apresentado. O tratamento convencional da fístula aorto-brônquica é a cirurgia aberta de aorta torácica, com reconstrução traqueobrônquica. Recentemente, o reparo endovascular tem sido proposto como uma alternativa. Os autores apresentam um relato de tratamento endovascular, realizado com êxito, de pseudoaneurisma de aorta torácica com fístula aorto-brônquica 22 anos após cirurgia para correção de coarctação aórtica.

Aortobronchial fistula is an abnormal passage between the aorta and the bronchus, and even when recognized and treated promptly, it carries a high risk of fatality. It can develop after aortic operations, and it is usually the result of a pseudoaneurysm. Massive or intermittent hemoptysis is the main symptom. Conventional treatment of aortobronchial fistula is open surgery of the thoracic aorta with tracheobronchial reconstruction. Recently, endovascular repair has been proposed as an alternative. The authors report a case of successful endovascular treatment of thoracic aortic pseudoaneurysm with aortobronchial fistula, 22 years after surgical correction of the aortic coarctation.

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.

Hemoptisis/hemorragia pulmonar en pediatría / Pulmonary hemorrhage/hemoptysis in children

La hemoptisis es la presencia de sangre en el esputo originada en los bronquios o pulmones. La historia clínica puede dar información de la cuantía del sangrado y diferenciar la hemoptisis de la hematemesis. La hemoptisis en niños es poco frecuente, las diferentes casuísticas dependen del interés del centro donde estos pacientes son referidos. Las causas más frecuentes de hemoptisis son las infecciones respiratorias bajas, aspiración de cuerpo extraño, traumatismos, fibrosis quística, cardiopatías congénitas. Otras causas son mucho menos frecuentes, como el síndrome de hemorragia alveolar difusa, con capilaritis pulmonar, como parte de una enfermedad sistémica (síndrome pulmonarrenal) y sin capilaritis pulmonar, con y sin causa cardiovascular. La radiografía de tórax es mandatoria pero una radiografía normal no descarta una hemorragia pulmonar. La tomografía computada es necesaria para la detección de lesiones pulmonares. La broncoscopía es fundamental para estudiar la vía aérea, toma de muestras mediante lavado broncoalveolar (LBA) y durante un sangrado activo poder localizar su origen. La hemosiderosis pulmonar idiopática es un diagnóstico de exclusión, el hallazgo de hemosiderófagos en el LBA confirma el diagnóstico. El manejo va dirigido a tratar la hipoxemia, la inestabilidad hemodinámica, el cese de la hemorragia y el tratamiento de la enfermedad de base. Esta revisión discute las etiologías de la hemoptisis y hemorragia pulmonar, proponiendo un algoritmo diagnóstico. La hemosiderosis pulmonar idiopática es tratada más detalladamente.

Indications and complications of bronchoscopy: an experience of 100 cases in a tertiary care hospital

To enlist the frequency of indications and complications of flexible fibreoptic bronchoscopy in a tertiary care hospital. A total of 100 patients admitted to Chest and medical units of Lady Reading hospital Peshawar who needed bronchoscopy were selected irrespective of their age, sex, occupation. All patients in whom bronchoscopy was indicated were included in the study. After detailed clinical history with thorough physical examination and relevant investigations, Bronchoscopy was performed with Olympus fibreoptic bronchoscope. Relevant data were recorded for analysis. Out of 100 patients, 64 [64%] were male, and 36 [36%] were female. Majority of patients [55%] were above 50 years of age. In 60% patients, there was radiographic abnormality on chest X-ray and C.T scan. In 25 [25%], the indication was unexplained hemoptysis and 2 [2%] patients had hoarseness. Another 13 [13%] patients were bronchos coped to see Acid Fast Bacilli in bronchial wash. These patients were suspected to have Tuberculosis but sputum smears were reported negative on repeated examinations. Complications which occurred in these patients included Pneumothorax [1%], hemorrhage [1%], hypoxemia [4%], Atrial tachycardia [3%], bronchospasm [2%], and post-bronchoscopy fever [2%]. These complications were managed accordingly and all patients recovered without any serious consequences. Most of the indications for Bronchoscopy in this hospital are diagnostic rather than therapeutic. Most common indications include radiographic abnormalities, hemoptysis, hoarseness and for isolation of ABF

Descending thoracic aortic aneurysm presenting as left sided hemorrhagic pleural effusion.

Aneurysm of descending thoracic aorta, in majority of cases is diagnosed either by chance in routine chest imaging for some other reasons or rarely due to it's symptomatic presentation like chest pain and other mediastinal compression symptoms. In this case report we present a case of 69 year old smoker who presented with cough, hemoptysis and left sided massive painless hemorrhagic pleural effusion. Further investigation revealed a large aneurysm of descending thoracic aorta which infiltrated the left lung. We suggest descending thoracic aneurysm be included in the differential diagnosis of this sort of clinical presentation which otherwise imperative with the clinical scenario of bronchogenic carcinoma.

Utilidad de broncofibroscopia flexible en el diagnóstico de las causas de hemoptisis / Utility of broncofibroscopia flex in the diagnosis of the reasons of hemoptisis

Se realizó estudio descriptivo prospectivo para evaluar la utilidad de la broncofibroscopia flexible en el diagnóstico de las causas de hemoptisis. Se realizaron 60 broncofibroscopias. Las hipótesis planteadas como primera posibilidad fueron de etiología Infecciosa 52 (86.7 por ciento), de etiología neoplßsica 6 (10 por ciento) y de otras causas 2 (3.3 por ciento). Resultados Bacteriológicos: de 48 pacientes con sospecha de tuberculosis 12 (25 por ciento) resultaron con baciloscopias positivas; obteniéndose el mejor rendimiento mediante el aspirado bronquial (100 por ciento). De 17 pacientes con sospecha de otra causa infecciosa 11 (64.7 por ciento) resultarón positivas para gérmenes comunes y hongos y 6 (35.3 por ciento) negativas. De 14 pacientes con estudio citológico de papanicolau (PAP)13 (92.9 por ciento) no presentaron Células Sospechosas de Neoplasias (NCSN) y en 1 (7.1 por ciento) se evidenciaron Células Sospechosas de Neoplasia (CSN). En 41 pacientes con biopsias bronquiales los resultados fueron: bronquitis crónica 25 (61 por ciento), bronquitis crónica y aguda 07 (17.1 por ciento), metaplasia epidermoide 02 (4.9 por ciento), granuloma tuberculoso 02 (4.9 por ciento), y 5 (12 por ciento) fueron informadas como muestra insuficiente. Conclusiones: Se demostró la importancia de la broncofibroscopía flexible en el diagnóstico de las causas de hemoptisis en nuestro medio, siendo el mayor aporte en la detección precoz de enfermedades infecciosas posibilitando su tratamiento oportuno con importantes beneficios epidemiológicos.

A descriptive and prospective study to evaluate utility of fiberoptic bronchoscopy in the diagnosis in hemoptisis was undertaken. Sixty fiberoptic bronchoscopy were done.The raised hypotheses as first possibility were of infectious etiology 52 (86.7 per cent) of neoplasic etiology 6 (10 per cent) and of other causes 2 (3,3 per cent). Bacteriological results: among 48 patients (with suspect tuberculosis), 12 patients (25 per cent) had positive acid fast bacilli smears. Among 17 samples that under went routine bacterial culture testing, 11 samples grew bacteria and fungal culture were positive, in 6(35.3 per cent) were negative. Cytological results: papanicolao smears were done in 14 patients, in 1 patients (7.1 per cent) suspicious neoplastic cells were detected. Histological results: In 41 patients, biopsy specimens were obtained, the following results were seen :: chronic inflammation in 25 (61 per cent), chronic and acute bronchitis in7 (17,1 per cent), epidermoid metaplasia 2 (4,9 per cent ), tuberculous granuloma in 2 (4,9 per cent), and 5 (12 per cent) were informed, as it shows insufficient specimens. Conclusions: The importance of the use of the flexible fiberoptic bronchoscopy was demoustrated in the diagnosis of the causes of hemoptisis, contributing the most to the early diagnosis of infectious diseases which results inopportune treatment and epidemiologic benefit.

Cavernostomia em aspergiloma pulmonar complexo / Cavernostomy for complex pulmonary aspergilloma

A ressecção pulmonar, nos casos de aspergiloma pulmonar, previne a recorrência da hemoptise; entretanto, a lobectomia nem sempre é considerada apropriada quando o risco operatório é elevado. A cirurgia pleuropulmonar, no aspergiloma, é considerada de risco e, no aspergiloma pulmonar complexo, está associada a morbidade alta, sendo contra-indicada em pacientes com a função pulmonar comprometida e naqueles com doença pulmonar bilateral. O prognóstico está relacionado, principalmente, às condições gerais dos pacientes. A cavernostomia é uma alternativa eficaz de tratamento nos pacientes com alto risco, podendo ser utilizada em alguns pacientes com aspergiloma complexo, função pulmonar comprometida e doença bilateral. Nós realizamos ressecção costal, cavernostomia e retirada total do aspergiloma. O procedimento é tecnicamente fácil de ser realizado, o risco é baixo e preserva parênquima pulmonar.