1/20. Haemoptysis after breath-hold diving.Pulmonary oedema has been described in swimmers and self-contained underwater breathing apparatus (Scuba) divers. This study reports three cases of haemoptysis secondary to alveolar haemorrhage in breath-hold divers. Contributory factors, such as haemodynamic modifications secondary to immersion, cold exposure, exercise and exposure to an increase in ambient pressure, could explain this type of accident. Furthermore, these divers had taken aspirin, which may have aggravated the bleeding.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/20. Fatal pulmonary haemorrhage during anaesthesia for bronchial artery embolization in cystic fibrosis.Three children with cystic fibrosis (CF) had significant pulmonary haemorrhage during anaesthetic induction prior to bronchial artery embolization (BAE). Haemorrhage was associated with rapid clinical deterioration and subsequent early death. We believe that the stresses associated with intermittent positive pressure ventilation (IPPV) were the most likely precipitant to rebleeding and that the inability to clear blood through coughing was also an important factor leading to deterioration. Intermittent positive pressure ventilation should be avoided when possible in children with CF with recent significant pulmonary haemorrhage.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
3/20. amniotic fluid embolism.amniotic fluid embolism is a rare occurrence, with no single pathognomonic clinical or laboratory finding. diagnosis is based on clinical presentation and supportive laboratory values. We describe the case of a 17-year-old nulliparous woman at 27 weeks' gestation who had uterine bleeding, hematuria, hemoptysis, hypotension, dyspnea, and hypoxemia within 30 minutes of vaginal delivery. Laboratory values revealed diffuse intravascular coagulation. Chest films were consistent with adult respiratory distress syndrome. pulmonary artery catheterization revealed moderately increased pulmonary capillary wedge pressure. Supportive measures, including oxygenation, fluid resuscitation, and plasma, were administered. Central hemodynamic monitoring and inotropic support were necessary. Our patient recovered uneventfully and 6 weeks later was living an unrestricted life-style.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/20. hemoptysis provoked by voluntary diaphragmatic contractions in breath-hold divers.Pulmonary barotrauma of descent (lung squeeze) has been described in breath-hold divers when the lung volume becomes smaller than the residual volume (RV), with the effect of increased ambient pressure. However, the ratio between the total lung capacity and the RV is not the only factor that plays a role in the lung squeeze. blood shift into the thorax is another important factor. We report three cases of hemoptysis in breath-hold divers who dove for spear fishing in shallower depths than usual. All of the divers performed voluntary diaphragmatic contractions at the beginning of their ascent, while their mouths and noses were closed. We suggest that the negative intrathoracic pressure due to the forced attempt to breathe in with voluntary diaphragmatic contractions contributes to alveolar hemorrhage, since it may damage the pulmonary capillaries.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
5/20. Haemoptysis as a late complication of a Mustard operation treated by balloon dilation of a superior caval venous obstruction.Haemoptysis was the presenting symptom in a 27-year-old male. He had undergone a Mustard operation for connection of complete transposition at the age of 2 years. For 6 months prior to admission, he had complained of dyspnoea without chestpain, and swelling of the fingers during hard physical work. Chest radiography and computer tomographic scans showed normal features of the pulmonary parenchyma, and no sign of cardiomegaly or vascular stasis. Fiberoptic bronchoscopy demonstrated a blood clot in the upper right bronchus, without any associated abnormalities of the bronchial tree. Doppler echocardiography showed obstruction of the superior caval vein, which was verified by cardiac catheterization. Balloon dilation at the site of obstruction increased the diameter of the vein from 0.5 to 1.7 cm, and the mean pressure in the superior caval vein was reduced significantly from 18 to 10 mmHg. The haemoptysis did not recur, and no complaints of dyspnoea or swelling of fingers during physical activity was reported 2 years later. Transthoracic echocardiography undertaken at this time revealed no obstruction of the superior caval vein. We conclude that hemoptysis is a rare complication of increased venous pressure in the upper body of patients with superior caval venous obstruction, which can be treated by balloon dilation or stenting.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
6/20. Pulmonary capillary hemangiomatosis associated with primary pulmonary hypertension: report of 2 new cases and review of 35 cases from the literature.Pulmonary capillary hemangiomatosis (PCH) is a rare cause of primary pulmonary hypertension characterized by thin-walled microvessels infiltrating the peribronchial and perivascular interstitium, the lung parenchyma, and the pleura. These proliferating microvessels are prone to bleeding, resulting in accumulation of hemosiderin-laden macrophages in alveolar spaces. Here we report 2 cases of PCH with pulmonary hypertension, 1 of them associated with mechanical intravascular hemolysis, a feature previously reported in other hemangiomatous diseases, but not in PCH. Case 2 was diagnosed by pulmonary biopsy; to our knowledge the patient is the second adult to be treated with interferon alpha-2a. review of the literature identified 35 patients with PCH and pulmonary hypertension. The prognosis is poor and median survival was 3 years from the first clinical manifestation. dyspnea and right heart failure are the most common findings of the disease. hemoptysis, pleural effusion, acropachy, and signs of pulmonary capillary hypertension are less common. Chest X-ray or computed tomography scan usually shows evidence of interstitial infiltrates, pulmonary nodules, or pleural effusion. Hemodynamic features include normal wedge pressures. Radiologic and hemodynamic findings are undifferentiated from those of pulmonary veno-occlusive disease but differ from other causes of primary pulmonary hypertension. epoprostenol therapy, considered the treatment of choice in patients with primary pulmonary hypertension, may produce pulmonary edema and is contraindicated in patients with PCH. Regression of lesions was reported in 1 patient treated with interferon therapy and 2 other patients stabilized, including our second patient. PCH was treated successfully by lung transplantation in 5 cases. Early recognition of PCH in patients with suspected primary pulmonary hypertension is possible based on clinical and radiologic characteristics. diagnosis by pulmonary biopsy is essential for allowing appropriate treatment.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/20. Fatal hemorrhagic pneumonia caused by infection due to Kytococcus sedentarius--a pathogen or passenger?A 55-year old man developed a hemorrhagic pneumonia, likely due to infection with Kytococcus sedentarius during neutropenia following induction chemotherapy for acute myeloid leukemia. Severe mucosal barrier injury and the selective pressure of broad-spectrum antibiotics probably made it possible for this normally harmless commensal to penetrate the gut, spread through the blood stream, and invade the lungs.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/20. Massive pulmonary hemorrhage from dual circulation pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia.Pulmonary arteriovenous malformations (AVMs) are commonly supplied by the pulmonary arterial system and rarely by the systemic bronchial circulation. The authors outline the case of a young woman with pulmonary AVMs as part of hereditary hemorrhagic telangiectasia with the uncommon presentation of massive hemoptysis. Management of her recurrent, life-threatening pulmonary hemorrhage was complicated by pulmonary AVMs that were supplied by both the pulmonary and systemic bronchial arterial circulatory systems. Transcatheter embolotherapy of the higher pressure bronchial systemic circuit was necessary for acute hemostasis.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/20. Pulmonary arteriovenous malformation causing massive haemoptysis and complicated by coronary air embolism.We report the case of a 20-year-old man with possible Osler-Rendu-Weber syndrome (hereditary haemorrhagic telangiectasia) who developed an episode of massive haemoptysis from a bleeding pulmonary arteriovenous malformation in the left lower lobe of his lung. During the acute haemorrhage, he also appeared to suffer a coronary air embolism, possibly due to introduction of air into the bleeding arteriovenous malformation during intermittent positive pressure ventilation through the endotracheal tube. His electrocardiogram showed extensive ST elevation (>2 mm) in the inferolateral leads associated with raised troponin i and creatine kinase levels. These changes resolved within thirty minutes. The pulmonary arteriovenous malformation was successfully treated with a combination of alcohol injection and coil embolization.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/20. hemoptysis and breath-holding diving.OBJECTIVE: We aim to present one case with hemoptysis. Pulmonary barotrauma of descent (lung squeeze) has been described in breath-hold divers when the lung volume becomes smaller than the residual volume, with the effect of increased ambient pressure. methods: We report one case of hemoptysis in a breath-hold diver who dove for exercise of military action. RESULTS: The patient's hemoglobin and hematocrit levels were 7.3 g/dL and 26%, respectively. The computed tomography of thorax obtained 5 hours after the diving event revealed images suggestive of hemoptysis. The diagnosis of hemoptysis was made based on the diver's history and computed tomography findings. All of the divers performed voluntary diaphragmatic contractions at the beginning of their ascent, while their mouths and noses were closed. CONCLUSION: We suggest that the negative intrathoracic pressure attributable to the forced attempt to breathe along with voluntary diaphragmatic contractions contributes to hemoptysis, since it may damage the pulmonary capillaries.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
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