Haemoptysis in healthy children due to unsuspected foreign body

Abstract: Haemoptysis in otherwise healthy children is an uncommon event. Two cases of massive haemoptysis, subsequently requiring lobectomy, are discussed. In each case, foreign vegetable matter was identified despite previously normal bronchoscopy and minimal changes on chest radiograph.     

Haemoptysis: A case report with tetralogy of Fallot with absent pulmonary valve leaflets and anomalous origin of left pulmonary artery

A 6 month old female child with tetralogy of Fallot with absent pulmonary valve leaflets and anomalous origin of left pulmonary artery was admitted to hospital with a mild adenoviral lower respiratory tract infection. She had a large haemoptysis 1 week after admission, and recovered with simple supportive measures. This case illustrates a previously unreported complication of a rare anomaly.     

Respiratory bronchiolitis associated interstitial lung disease (RB-ILD) presenting with haemoptysis

Respiratory bronchiolitis associated interstitial lung disease is an uncommon condition in current or ex-smokers. The presentation is non-specific, but haemoptysis is uncommonly reported in this condition. We report the case of a 25-year-old woman who presented with significant haemoptysis, dyspnoea, reduced transfer factor and normal clinical examination. In addition, a Medline literature search was performed to review the clinical features and prognosis of this disease. Other causes of haemoptysis were excluded with extensive investigation. The diagnosis was made on thoracoscopic lung biopsy. The patient had significant postoperative complications of prolonged air leak and hydropneumothorax requiring further surgery and prolonged hospital stay. Advice regarding smoking cessation was given. Her pulmonary physiology remains abnormal on follow up but symptoms have improved. Respiratory bronchiolitis-ILD may present with normal examination and radiology. Haemoptysis in this case may have been associated with the underlying disease but could have been incidental. Diagnosis, in general, requires lung biopsy. As in this patient, lung function does not appear to improve significantly on follow up.     

Endobronchial metastasis of renal cell carcinoma

Endobronchial metastasis from nonpulmonary carcinoma is rare. A case of metastatic renal cell carcinoma is presented and the literature reviewed. Severe haemoptysis was the initial symptom leading to the finding of a bronchial polypoid mass.     

纤支镜下一次置入2根双腔微导管在治疗肺大咯血中的价值及安全性评价

目的探讨纤维支气管镜(纤支镜)下一次性置入2根新型双腔微导管在治疗肺大咯血中的价值及安全性。方法 10例患者均先行X线胸片、胸部HRCT检查,初步明确出血部位及病因,按纤支镜操作常规准备。术前30min无水吞服30mg可待因,尽可能在大咯血间歇期进行。操作过程中边插入纤支镜边止血,直至找到目标支气管,随即沿工作通道放入引导导丝,在纤支镜直视下沿导丝放入第1根双腔微导管。判定球囊所能寻求支撑的着力点后,依据管径大小向球囊导管工作通道分别注入不等量冰生理盐水固定球囊。随后观察另一段或亚段支气管是否仍在持续出血,再继续按上述方法置入第2根球囊导管。纤支镜下观察3～5min,确定封堵目标支气管已停止出血后退出纤支镜。每隔1～2h向球囊的工作通道注入凝血酶500U,并回抽以观察微球囊封堵支气管内出血情况,以确定球囊导管放置时间。每6～8h回抽固定球囊液体量的一半,避免完全放松固定球囊而导致导管在气管内随呼吸发生移位。如在此期间或之后再次出现大咯血,则立即进行支气管动脉栓塞或手术治疗。以术后患者咯血量等症状的减轻,并结合从工作通道回抽吸液体颜色深浅的改变情况,分为出血完全停止、明显减少、有所减少、失败无效等4个层次进行疗效的判断。并通过该项技术与支气管动脉栓塞术(BAE)治疗肺大咯血对作比观察。结果 10例患者纤支镜下一次置入2根新型微导管操作顺利,操作时间约20～30min。大咯血即刻控制率达80%。术后出血即刻完全停止4例、明显减少3例、有所减少1例、失败无效2例。出血有所减少的1例术后4h经BAE术疗出血完全停止。失败无效的2例中,1例后经外科手术切除右肺中叶,出血完全停止。另外1例随即行BAE,但术后24h再次出现大咯血窒息死亡。结论一次性置入2根新型微导管治疗肺大咯血为有条件的患者和可能需要进一步行BAE,及外科手术治疗的患者创造了诊断和气道准备条件的时间。具有一定临床应用价值及可靠的安全性,值得在临床进一步推广应用。     

Therapeutic embolization of systemic arterial supply to normal basal segments of the left lower lobe of the lung

Systemic arterialization of normal lung without sequestration is a rare congenital abnormality. The basal segments of the left lower lobe are most frequently involved. The involved lung has no structural abnormalities of the tracheobronchial tree that distinguish this abnormality from bronchopulmonary sequestration. Haemoptysis and exertional dyspnoea are common presenting symptoms. We report the case of a 26-year-old man who presented with recurrent haemoptysis due to systemic arterialization of basal segments of the left lower lobe of the lung, without sequestration. Therapeutic embolization using metallic coils was successfully performed without any complications. There was no further haemoptysis during a 6-month follow up. Therapeutic embolization is a safe and effective method of managing the haemoptysis associated with aberrant systemic arterial supply to the normal lung.     

介入栓塞术治疗21例咯血的临床分析

目的探讨介入栓塞术治疗大咯血和反复咯血的临床价值。方法回顾性分析介入栓塞术治疗的21例大咯血和反复咯血患者的疗效及并发症。结果 21例中,立即止血18例,3例术后出血量减少,经内科治疗48h内出血停止。术后随访6个月,2例1个月内复发,经第2次治疗成功。胸痛、腹胀、发热是主要并发症。结论介入栓塞术治疗咯血,止血迅速,安全,疗效理想。     

Haemoptysis and bronchial artery embolization in children

Haemoptysis varies in significance from trivial to fatal. The most common causes in children are tuberculosis, fungal infections and bronchiectasis of any cause. In populations of European origin, cystic fibrosis is the most common predisposing factor. Chronic or life-threatening haemoptysis requires further investigation. Various forms of treatment are possible, and management is optimized when a multidisciplinary team is available.Bronchial artery embolization (BAE) is effective in controlling haemoptysis in most cases, although recurrent bleeding is not uncommon. BAE is often technically challenging, however, and requires angiographic skills that are not always available in children's hospitals. Although the procedure is usually regarded as relatively safe, complications are not uncommon and may be severe or even fatal.     

Haemoptysis as a prognostic factor in lung adenocarcinoma after curative resection

Background:

Haemoptysis is a common symptom of lung cancer. Its prognostic role and mechanisms are still poorly understood.

Methods:

We retrospectively reviewed 666 consecutive patients with primary lung adenocarcinoma who underwent complete resection. The prognostic value of haemoptysis with respect to overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS) was analysed. To further explore the possible mechanisms of haemoptysis, we evaluated vascular endothelial growth factor (VEGF) expression, tumour necrosis, vascular invasion and extratumoural microvessel density (MVD) in 112 randomly selected patients.

Results:

Haemoptysis predicted poor OS, DSS and DFS in operable lung adenocarcinoma (all P<0.001). In addition, haemoptysis was associated with high white blood cell (WBC) count (P=0.032), high fibrinogen (Fib; P<0.001), high tumour greatest dimension (P<0.001), severe vascular invasion (P=0.002) and central tumour location (P<0.001). We obtained no statistically significant differences of VEGF expression, tumour necrosis and extratumoural MVD in haemoptysis and non-haemoptysis groups.

Conclusion:

Our study demonstrates that haemoptysis predicts poor OS, DSS and DFS in lung adenocarcinoma after curative resection. Vascular invasion rather than angiogenesis or tumour necrosis could be the most important mechanism of haemoptysis in lung adenocarcinoma.