Catamenial haemoptysis and clomiphene citrate therapy.
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Case reports of catamenial haemoptysis are uncommon. We report the first case of thoracic endometriosis associated with clomiphene citrate therapy and previously unpublished endobronchial and angiographic findings. (+info)
Anesthetic management of a parturient undergoing cesarean section with a tracheal tumor and hemoptysis.
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Anesthetic management of a parturient with respiratory failure associated with hemoptysis, dyspnea, and orthopnea is difficult. An anesthesiologist should realize that the patient's major problem is not solved during the surgery. This circumstance is similar to a patient with associated cardiac disease scheduled for non-cardiac surgery. General anesthesia with endotracheal intubation can provide safe oxygenation for both the parturient and the fetus, but with possible unexpected massive hemoptysis and tumor seeding. Prolonged intubation may delay the patient's pulmonary treatment course. Laryngeal mask anesthesia can provide an airway, but must not be secured due to the risk of aspiration. The need of high doses of inhalation drugs may hinder uterine contractions. The addition of a muscle relaxant will change the patient's respiratory patterns and physiology. Regional anesthesia alone might not be tolerated. A decrease in cough strength, as well as dyspnea, orthopnea, and hyperventilation may be harmful to both the parturient and the fetus. However, we successfully managed this case using epidural anesthesia combined with assisted mask ventilation instead of spontaneous breathing usually provided by a simple mask in almost all American Society of Anesthesiology (ASA) class I-II parturients during cesarean section. The anesthetic level was maintained at T8 with 18 ml of 2% Xylocaine mixed with 2 ml of 7% sodium bicarbonate with 1:200,000 epinephrine epidurally and with the patient in a supine position with the head up at 30 degrees to prevent cephalic spreading and to ensure better pulmonary ventilation. (+info)
The pulmonary physician in critical care. Illustrative case 1: cystic fibrosis.
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The case history of a patient with CF admitted to an ICU is presented and the appropriateness of intensive care management for patients with CF is discussed. Issues relevant to the ICU care of patients with CF are highlighted. (+info)
A 61 year old man died after presenting with a 24 h history of haematemesis and haemoptysis, and one year history of hoarseness of voice. Post-mortem examination showed a dental plate eroding through the mid-oesophagus into a bronchus and into the descending arch of the aorta, with scarring suggestive of old perforation. An organized haematoma also involved the left recurrent laryngeal nerve. Vocal cord paralysis may be a manifestation of foreign body-induced oesophageal perforation, which can lead to death from an oesophago-broncho-aortic fistula. Both complications of oesophageal perforation from a foreign body have not to our knowledge been previously reported. (+info)
GOODPASTURE'S SYNDROME: PULMONARY HEMOSIDEROSIS WITH GLOMERULONEPHRITIS.
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Three cases of Goodpasture's syndrome (pulmonary hemosiderosis and glomerulonephritis) are described. Each presented with unexplained hemoptysis and subsequently developed glomerulonephritis which caused uremia. These cases include the youngest and the oldest individuals yet reported with the condition. Steroid therapy was administered to one patient but apparently did not influence the course of the disease. The variations in the clinical course and the pathology of the disease are discussed. (+info)
Pulmonary intralobar sequestration accompanied by aneurysm of an anomalous arterial supply.
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A 47-year-old woman presented with hemoptysis and her chest X-ray films showed an opacity suggesting a mass in the left lower lung field. Based on radiographic investigations, the mass was diagnosed as an aneurysm develop in an anomalous vessel and was considered to be a Pryce type I pulmonary intralobar sequestration. Resection of the left lower lobes was performed and the aneurysm was found to be filled with thrombus. It is rare for an aneurysm to form in an aberrant vessel. This complication may have been the result of regional sclerosis affecting the anomalous artery as well as systemic atherosclerosis. (+info)
Massive haemoptysis after living donor liver transplantation.
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A 27 year old man with hereditary haemorrhagic telangiectasia who developed progressive liver dysfunction underwent living related right lobe transplantation. Pulmonary arteriography did not reveal arteriovenous malformation or abnormal intrapulmonary venous channels. The postoperative course was characterised by persistent hypoxaemia and respiratory failure developed. On day 6, a massive haemoptysis developed and the patient died shortly thereafter. The native liver showed a nodular pseudocirrhotic transformation, with highly dilated and irregularly interconnected vein-like or arterial-like structures in the fibrous septa. Pathological examination of both lungs showed irregular thickening of the wall of the arteries, secondary to eccentric and/or concentric myointimal hyperplasia. This case suggests that massive haemoptysis can develop even when arteriovenous malformations are undetectable by pulmonary arteriography, and it questions the role and the appropriateness of living donor liver transplantation in high risk patients. (+info)
Endobronchial findings of fibrosing mediastinitis.
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Fibrosing mediastinitis is underdiagnosed because of the nonspecific character of the presenting symptoms. The endobronchial findings obtained via flexible bronchoscopy are not defined in the literature. We describe 3 cases of fibrosing mediastinitis, most likely caused by histoplasmosis. All 3 patients presented with hemoptysis and were found to have tracheobronchial concentric narrowing, severe hyperemia, and mucosal edema. The hyperemic blood vessels were treated with neodymium yttrium-aluminum-garnet (Nd:YAG) laser and argon plasma coagulation. We believe that recognition of specific endobronchial findings aids in prompt diagnosis of fibrosing mediastinitis. (+info)