[Two cases of recurrent, massive hemoptysis with contralateral, concurrent hemoptysis].

Bilateral, concurrent massive hemoptysis with respiratory failure is rare and difficult to manage. We encountered two patients with this condition. One was a 51-year-old woman and one was a 63-year-old woman. Both had inactive pulmonary tuberculosis and episodes of hemoptysis. Home oxygen therapy was prescribed to the former patient and bronchial artery embolization was done in the latter. The sites of initial bleeding were in the left basal segment and in the lingular segment. Bleeding was well controlled by endobronchial tamponade with a Fogarty balloon catheter in the left main bronchus, contralateral intubation, and systemic artery embolization. Use of water instead of air in the balloon was more effective in over the long term. Concurrent bleeding from the contralateral upper lobe bronchus was controlled by compression with a tracheal tube cuff at the bronchial orifice. Afterward, an infiltrative shadow was seen on the chest X-ray film and hemoptysis occurred in case 2 occurred in case 2. Treatment with erythromycin and antituberculosis drugs brought about improvement of chest X-ray findings and disappearance of the hemoptysis.

[Clinical studies on nine cases with miliary tuberculosis: serum level of tumor markers and bronchoscopy in differential diagnosis].

We analyzed retrospectively the clinical data of 9 patients with miliary tuberculosis who had been treated in Kyoto City Hospital during the past 12 years. Majority of our patients were female (7 of 9) and were of elder age-groups (mean age: 68.5 years, range: 56-85 years). The most common symptoms at the first visit were fever, fatigue and loss of appetite, but respiratory symptoms were rather rare and moderate. Some cases showed normal chest radiograms at the onset, but during the course of the disease miliary shadows were noticed in all cases. Tuberculin test and smear examination of sputum were not diagnostic. In 4 cases, fiberoptic bronchoscopy had been performed together with bronchoalveolar lavage (BAL), bronchial washing and transbronchial lung biopsy (TBLB). Smear examination BAL-fluid or bronchial washing for acid-fast bacilli was positive in all 4 cases tested. In 7 cases, serum level of tumor markers (CEA, TPA, SLX, NSE, SCC, CA19-9, CA125, DU-PAN 2 and Elastase I) had been measured under the suspicion of malignant diseases. CEA had elevated in 6 cases, NSE in 2 cases, SLX, TPA, CA19-9, CA125 and DU-PAN 2 in 1 case each, and, as a whole, at least one tumor marker had elevated in 6 of 7 cases tested. Though the degree of such elevation of tumor markers had not been so remarkable except for CA125 in a patient who had been complicated with tuberculous peritonitis, but from these results malignancy had not been' able to rule out.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of solitary bronchial papilloma and a review of the literature].

A case of solitary bronchial papilloma which is one of the rarest of pulmonary benign tumors is reported. A 25-year-old male was admitted to our hospital with an abnormal chest shadow. Bronchoscopy revealed a tumor at the orifice of left B6. The biopsy specimen of the tumor was diagnosed as a papilloma. Left S6 sleeve segmentectomy was performed to preserve lung function. The tumor was like a cauliflower and 4 x 4 x 4 cm in size. The histological diagnosis was bronchial papilloma. Since there are some reported cases of solitary bronchial papilloma with carcinoma in situ, such cases must be treated surgically when possible.

MRI of mediastinal cavernous hemangioma.

A cavernous hemangioma of the anterior mediastinum was studied by CT and MRI. CT did not give the diagnosis of the vascular tumor but MRI demonstrated the morphology of the vascular tumor. MRI is very useful for detecting a vascular tumor in the mediastinum.