ABSTRACT
We describe four cases of actinomycotic intracavitary lung colonization and review the literature on the subject. Aspergillus fumigatus, A. niger, A. flavus, Pseudallescheria boydii are responsible for the majority of fungi intracavitary lung colonization (fungus ball). The similarities in clinical symptom (haemoptysis) and radiologic feature (pulmonary air meniscus) of fungus ball and actinomycotic intracavitary colonization prompted the investigation into a range of microorganisms, including Nocardia spp. and Actinomyces spp. We report four cases of such actinomycotic syndrome, three of them in diabetic patients, and review briefly the literature.
Subject(s)
Actinomycosis/pathology , Diabetes Complications , Lung Diseases/pathology , Actinomycosis/complications , Adult , Aged , Female , Humans , Lung Diseases/complications , Lung Diseases, Fungal/pathology , Male , Middle AgedABSTRACT
Seventy-five patients with hemoptysis were treated with bronchial artery embolization (BAE). The procedure was performed with Hexabrix (sodium methylglucamine ioxaglate), Mikaelson catheters, and Gelfoam particles. Angiographic evaluation of the bronchial artery anatomy revealed ten different configurations, which are described. The embolization attempt failed in three cases (4%); eight additional patients (10.7%) were excluded from the series because of inadequate data. In the remaining 64 patients, 41 underwent BAE alone and 23 underwent either chemotherapy or surgery in addition to embolization. Immediate control of hemoptysis was achieved in 49 of 64 patients (76.6%). Long-term control of hemoptysis was achieved in 46 of the 56 patients included in the long-term follow-up (82.1%). Eight of the 64 patients were lost to follow-up, which ranged from one to 47 months (mean 24.8 months). Hemoptysis recurred in 12 of 56 patients (severe in 10, mild in 2) (21.4%). Twelve patients died (21.4%), five of them due to hemoptysis (8.9%). None of the patients who died of hemoptysis had responded to initial BAE. It is concluded that BAE is an effective treatment for immediate control of life-threatening hemoptysis, allowing long-term control of bleeding in the majority of patients.
Subject(s)
Bronchial Arteries , Embolization, Therapeutic/methods , Hemoptysis/therapy , Adult , Aged , Bronchial Arteries/diagnostic imaging , Embolization, Therapeutic/adverse effects , Female , Follow-Up Studies , Hemoptysis/diagnostic imaging , Hemoptysis/drug therapy , Hemoptysis/surgery , Humans , Male , Middle Aged , Radiography , RecurrenceABSTRACT
Massive hemoptysis is a major clinical and surgical problem with a mortality of 80%, which is most often related to asphyxiation. Thirty-three patients with massive hemoptysis underwent selective bronchial arteriography and treatment by embolization or surgery. Lasting control of hemoptysis was achieved in 27 of 33 patients (81.8%) at follow-up ranging from one to 24 months. Hemoptysis recurred in six of 33 patients (18.2%). Mortality related to hemoptysis was three of 33 patients (9.0%), and overall mortality was six of 33 patients (18.2%). Seven patients underwent surgical treatment in addition to bronchial artery embolization. Patients with mycetoma suffered the highest relapse of bleeding and the highest mortality in this series. In these patients, bronchial artery embolization may be effective in the control of acute bleeding, but permanent control of hemoptysis is achieved only by later surgery. Bronchial artery embolization is an effective way to control massive hemoptysis with a low recurrence rate and reduced mortality among severely ill patients. Although we have had no unfavorable sequelae, reports of neurological damage following bronchial angiography indicate care in avoiding obstruction of the artery of Adamkiewicz.
