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Journal of Ultrasound in Medicine :... Aug 2023Lung ultrasound (LUS) is a powerful and accessible clinical tool for pulmonary diagnosis, but risk of pulmonary capillary hemorrhage (PCH) presents a safety issue. The...
OBJECTIVES
Lung ultrasound (LUS) is a powerful and accessible clinical tool for pulmonary diagnosis, but risk of pulmonary capillary hemorrhage (PCH) presents a safety issue. The dependence of PCH in a rat model of LUS was evaluated for image frames-per-second (fps) and associated on-screen Mechanical Index (MI ) and Thermal Index (TI).
METHODS
A Philips iE33 machine with L15-7io probe was used to scan anesthetized rats in a warmed water bath. B mode was applied at 9 MHz with settings of 34, 61 and 118 fps. After 2 minutes of exposure at an MI setting, samples were obtained for assessment of PCH areas on the lung surface. Ultrasound parameters were measured to determine the in situ MI at the lung surface.
RESULTS
The PCH trend counter-intuitively decreased with increasing fps, with areas of 19.5 mm for 34 fps (MI = 1.0, TI = 0.8, 4080 images), 9.6 mm at 61 fps (MI = 1.0, TI = 0.5, 7320 images) and 7.5 mm at 118 fps (MI = 1.1, TI = 0.4, 14,160 images). The PCH was not significantly different for 34 fps (TI = 0.5, MI = 0.8) (10.7 mm ), compared to 61 and 118 fps, above, indicating some value for the TI as a predictive indicator of PCH. MI thresholds were 0.42, 0.46, and 0.49 for 34, 61 and 118 fps, respectively.
CONCLUSIONS
The increase in PCH at low fps was associated with delivering more relatively high amplitude grazing pulse exposures during slower image scans. No significant PCH was found for the MI setting of 0.5, corresponding to in MI values of 0.35-0.39.
Topics: Rats; Animals; Rats, Sprague-Dawley; Disease Models, Animal; Lung Diseases; Lung; Hemorrhage
PubMed: 36723246
DOI: 10.1002/jum.16186 -
The Journal of Emergency Medicine May 2023Postlobectomy hemorrhage is rare. The majority of the bleeding happens early after surgery, with the median time to reoperation being 17 hours.
BACKGROUND
Postlobectomy hemorrhage is rare. The majority of the bleeding happens early after surgery, with the median time to reoperation being 17 hours.
CASE REPORT
A 64-year-old man with a lung nodule underwent video-assisted thoracic surgery right upper lobectomy 3 weeks prior and presented to the Emergency Department (ED) with acute-onset chest pain and shortness of breath in the setting of delayed hemothorax from acute intercostal artery bleeding. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The vast majority of the patients presenting to the ED with a hemothorax have a known history of trauma. It is important for emergency physicians to consider and recognize hemothorax in nontraumatic patients, especially those who underwent recent lung surgeries. Delayed postoperative hemorrhage is rare but possible, and can be life threatening.
Topics: Male; Humans; Middle Aged; Hemothorax; Thoracic Surgery, Video-Assisted; Chest Pain; Time Factors; Lung
PubMed: 37032206
DOI: 10.1016/j.jemermed.2023.02.002 -
Frontiers in Immunology 2021Stroke is a common central nervous system disease in clinical practice. Stroke patients often have infectious complications, such as pneumonia and infections of the...
Stroke is a common central nervous system disease in clinical practice. Stroke patients often have infectious complications, such as pneumonia and infections of the urinary tract and gastrointestinal tract. Although it has been shown that translocation of the host gut microbiota to the lungs and immune dysfunction plays a vital role in the development of infection after ischemic stroke, the occurrence and mechanism of pulmonary infection at different time points after hemorrhagic cerebral remain unclear. In this study, the changes in the immune system and intestinal barrier function in mice during disease development were investigated at 1 day (M 1 d), 3 days (M 3 d) and 7 days (M 7 d) following hemorrhagic stroke to clarify the mechanism of secondary pulmonary infection. The experimental results revealed that after hemorrhagic stroke, model mice showed increased brain damage from day 1 to 3, followed by a trend of brain recovery from day 3 to 7 . After hemorrhagic stroke, the immune system was disturbed in model mice. Significant immunosuppression of the peripheral immune system was observed in the M 3 d group but improved in the M 7 d group. Staining of lung tissues with hematoxylin and eosin (H&E) and for inflammatory factors revealed considerable disease and immune disorders in the M 7 d group. Stroke seriously impaired intestinal barrier function in mice and significantly changed the small intestine structure. From 1 to 7 d after stroke, intestinal permeability was increased, whereas the levels of markers for intestinal tight junctions, mucus and immunoglobulin A were decreased. Analysis based on 16S rRNA suggested that the microflora in the lung and ileum was significantly altered after stroke. The composition of microflora in lung and ileum tissue was similar in the M 7d group, suggesting that intestinal bacteria had migrated to lung tissue and caused lung infection at this time point after hemorrhagic stroke. In stroke mice, the aggravation of intestinal barrier dysfunction and immune disorders after intracerebral hemorrhage, promoted the migration of enteric bacteria, and increased the risk of pneumonia poststroke. Our findings reveal the dynamic process of infection after hemorrhagic stroke and provide clues for the optimal timing of intervention for secondary pulmonary infection in stroke patients.
Topics: Animals; Bacteria; Bacterial Infections; Bacterial Translocation; Cerebral Hemorrhage; Coinfection; Disease Models, Animal; Gastrointestinal Microbiome; Gene Expression; Humans; Intestinal Mucosa; Lung; Male; Mice, Inbred C57BL; RNA, Ribosomal, 16S; Stroke; Time Factors; Mice
PubMed: 34868020
DOI: 10.3389/fimmu.2021.767155 -
BMJ Case Reports Mar 2021Bronchopulmonary sequestration is a rare congenital pulmonary abnormality of the lower airways, which includes an abnormal and non-functioning lung tissue not...
Bronchopulmonary sequestration is a rare congenital pulmonary abnormality of the lower airways, which includes an abnormal and non-functioning lung tissue not communicating with the tracheobronchial tree and having aberrant blood supply from systemic circulation with variable venous drainage. The incidence of sequestration is around 0.15%-6.4% of all congenital lung malformations.Common presenting features are cough and expectoration. Misdiagnosed cases may present with recurrent infections and haemoptysis. CT of the chest with contrast is the imaging modality of choice.This is a case report of a 32-year-old woman who presented with cough and haemoptysis. CT of the chest showed a multiloculated mass-like lesion in the left lower lobe with a feeding artery from coeliac plexus and venous drainage via the normal left pulmonary vein.Based on CT chest findings, diagnosis of intralobar pulmonary sequestration was made. The patient was reviewed by cardiothoracic surgeons and underwent surgical resection of the sequestrated lung.Common presenting features are cough and expectoration. Misdiagnosed cases may present with recurrent infections and haemoptysis. CT of the chest with contrast is the imaging modality of choice.
Topics: Adult; Bronchopulmonary Sequestration; Cough; Female; Hemoptysis; Humans; Lung; Tomography, X-Ray Computed
PubMed: 33653840
DOI: 10.1136/bcr-2020-239140 -
BMC Pulmonary Medicine Jan 2022Hemorrhage is one of the most common complications of bronchoscopy. Although several hemorrhage risk factors have been proposed, it remains unclear whether blood... (Comparative Study)
Comparative Study
BACKGROUND
Hemorrhage is one of the most common complications of bronchoscopy. Although several hemorrhage risk factors have been proposed, it remains unclear whether blood pressure affects the onset of biopsy-induced endobronchial hemorrhage.
METHODS
We conducted a retrospective cohort study of 643 consecutive adults with lung cancer over an approximately 4-year period (from January 2014 to February 2018) at a large tertiary care hospital. Patients were divided into the hemorrhage group and the non-hemorrhage group based on endobronchial biopsy (EBB) findings. The association between systolic pressure (SP), diastolic pressure (DP), mean arterial pressure (MAP), pulse pressure (PP), PP to DP ratio (PP/DP) and the risk of EBB-induced hemorrhage was evaluated using multivariate regression analysis and smooth curve fitting adjusted for potential confounding factors.
RESULTS
The EBB-induced bleeding incidence was 37.8% (243/643) in our cohort. An independent association was found between PP/PD and the EBB-induced hemorrhage risk (per 1 SD, adjusted odds ratio, 0.788; 95% confidence interval, 0.653-0.951). The multivariate regression analysis performed using quartiles of PP/DP revealed that lower level of PP/DP ratio was related to a higher risk of EBB-induced hemorrhage (P for trend <0.05) after adjustment for potential confounders. However, no association was observed between SP, DP, MAP, PP and EBB-induced hemorrhage.
CONCLUSIONS
Low PP/DP was the independent risk factor for biopsy-induced endobronchial hemorrhage during bronchoscopy in patients with lung cancer.
Topics: Adult; Aged; Aged, 80 and over; Biopsy; Blood Pressure; Bronchi; Bronchoscopy; China; Female; Hemorrhage; Humans; Hypotension; Male; Middle Aged; Retrospective Studies; Risk Factors
PubMed: 34991557
DOI: 10.1186/s12890-022-01822-5 -
BMC Surgery Dec 2019In high-risk patients with complex pulmonary aspergilloma but unable for lung resection, cavernostomy and thoracoplasty could be performed. This study aimed to evaluate...
BACKGROUND
In high-risk patients with complex pulmonary aspergilloma but unable for lung resection, cavernostomy and thoracoplasty could be performed. This study aimed to evaluate this surgery compared two compressing materials.
METHODS
A total of 63 in high-risk patients who suffered from hemoptysis due to complex pulmonary aspergilloma and underwent cavernostomy and thoracoplasty surgery from November 2011 to September 2018 at Pham Ngoc Thach hospital were evaluated prospectively studied. Patients were allocated to two groups: the table tennis ball group and tissue expander group. We evaluated at the time of before operation, 6 months and 24 months after operation.
RESULTS
Tuberculosis was the most common comorbidity diseases in both groups. Upper lobe occupied almost in location. Hemoptysis symptoms plunged from time to time. Statistically significant Karnofsky score was observed in both groups. Postoperative pulmonary functions (FVC and FEV1) have remained in both groups at all time points. The remarkable results were no deaths related to surgery and low complications both short and long-term. There was no statistical significance between two groups in operative time, blood loss during operation, ICU length-stay time. Four patients died because of co-morbidity in 24 months follow-up.
CONCLUSION
Cavernostomy and thoracoplasty was safe and effective surgery for the treatment of complex pulmonary aspergilloma with hemoptysis in high-risk patients. No mortality related to surgery and low complications were recorded. The was no inferiority when compared two compressing materials .
Topics: Adult; Aged; Female; Hemoptysis; Humans; Length of Stay; Lung; Male; Middle Aged; Prospective Studies; Pulmonary Aspergillosis; Thoracoplasty; Treatment Outcome
PubMed: 31805919
DOI: 10.1186/s12893-019-0650-1 -
BMJ Case Reports Jan 2020Leptospirosisis a zoonosis caused by spirochaetes from the species The more severe form of leptospirosis, known as Weil's disease, is characterised by the triad of...
Leptospirosisis a zoonosis caused by spirochaetes from the species The more severe form of leptospirosis, known as Weil's disease, is characterised by the triad of jaundice, renal impairment and haemorrhages. Pulmonary involvement occurs in 20%-70% of the patients, with severity ranging from non-productive cough to respiratory failure mainly due to pulmonary haemorrhage. Recognition of Weil's disease in patients presenting with pulmonary symptoms can be difficult. This case illustrates a classic case of pulmonary haemorrhagic involvement in Weil's disease.
Topics: Adult; Diagnosis, Differential; Hematologic Tests; Hemorrhage; Humans; Lung Diseases; Male; Tomography, X-Ray Computed; Weil Disease
PubMed: 31996379
DOI: 10.1136/bcr-2018-227570 -
Revue Des Maladies Respiratoires Jun 2023Cannabis is the most widely used illicit psychoactive substance in France. It can be responsible for numerous pulmonary complications, including diffuse alveolar... (Review)
Review
Cannabis is the most widely used illicit psychoactive substance in France. It can be responsible for numerous pulmonary complications, including diffuse alveolar hemorrhage (DAH). The objective of this systematic review of the literature was to present data concerning the relationship between cannabis smoking and DAH, which has rarely been reported in the literature. The review was based on a Medline search covering the 1980-2022 period and utilizing data drawn from 10 articles. DAH diagnosis is based on an association of hemoptysis, anemia and diffuse alveolar opacities on chest radiography with siderophages in the Bronchoalveolar Lavage Fluid (BAL). The 11 patients identified in this review were daily or regular cannabis smokers; in 4 cases they presented recent or recurrent hemoptysis with anemia; imaging revealed diffuse alveolar opacities in 10 of them, while BAL endoscopy highlighted a diffuse hemorrhage in the bronchial tree, and siderophages were observed in 6 cases. While evolution was favorable when cannabis consumption was discontinued, resumption occasioned DAH recurrence, and one patient died. Advice to quit should systematically be accompanied by addictological follow-up.
Topics: Humans; Hemoptysis; Cannabis; Smokers; Pulmonary Alveoli; Hemorrhage; Lung Diseases; Anemia
PubMed: 37087352
DOI: 10.1016/j.rmr.2023.03.007 -
Current Pediatric Reviews 2023The assessment of hemostasis and the prediction of bleeding risk are of great importance to neonatologists. Premature infants are at an increased risk for bleeding,... (Review)
Review
The assessment of hemostasis and the prediction of bleeding risk are of great importance to neonatologists. Premature infants are at an increased risk for bleeding, particularly intra-cranial hemorrhages (most commonly intra-ventricular hemorrhages (IVH)), gastrointestinal hemorrhages, and pulmonary hemorrhages. All severe bleeding, but especially severe IVH, is associated with poor neurodevelopmental outcomes, and other than prenatal steroids, no intervention has reduced the incidence of this serious complication. As a result, there is a need in neonatology to more accurately identify at-risk infants as well as effective interventions to prevent severe bleeding. Unfortunately, the commonly available tests to evaluate the hemostatic system were established using adult physiologic principles and did not consider the neonate's different but developmentally appropriate hemostatic system. This review will describe the changes in the platelet count and tests of hemostasis throughout development, the limitations of these tests to predict neonatal bleeding and the utility of treating abnormal results from these tests with platelet and/or fresh frozen plasma (FFP) transfusions in non-bleeding infants.
Topics: Infant, Newborn; Infant; Adult; Humans; Platelet Count; Intensive Care Units, Neonatal; Blood Coagulation Tests; Hemorrhage; Hemostatics
PubMed: 36529926
DOI: 10.2174/1573396319666221216122444 -
Frontiers in Immunology 2021Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a major public health issue. COVID-19 is considered an airway/multi-systemic disease, and demise has been...
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a major public health issue. COVID-19 is considered an airway/multi-systemic disease, and demise has been associated with an uncontrolled immune response and a cytokine storm in response to the virus. However, the lung pathology, immune response, and tissue damage associated with COVID-19 demise are poorly described and understood due to safety concerns. Using post-mortem lung tissues from uninfected and COVID-19 deadly cases as well as an unbiased combined analysis of histology, multi-viral and host markers staining, correlative microscopy, confocal, and image analysis, we identified three distinct phenotypes of COVID-19-induced lung damage. First, a COVID-19-induced hemorrhage characterized by minimal immune infiltration and large thrombus; Second, a COVID-19-induced immune infiltration with excessive immune cell infiltration but no hemorrhagic events. The third phenotype correspond to the combination of the two previous ones. We observed the loss of alveolar wall integrity, detachment of lung tissue pieces, fibroblast proliferation, and extensive fibrosis in all three phenotypes. Although lung tissues studied were from lethal COVID-19, a strong immune response was observed in all cases analyzed with significant B cell and poor T cell infiltrations, suggesting an exhausted or compromised immune cellular response in these patients. Overall, our data show that SARS-CoV-2-induced lung damage is highly heterogeneous. These individual differences need to be considered to understand the acute and long-term COVID-19 consequences.
Topics: Aged; Aged, 80 and over; Autopsy; CD8-Positive T-Lymphocytes; COVID-19; Cytokine Release Syndrome; Epithelial Cells; Female; Hemorrhage; Humans; Inflammation; Lung; Lung Injury; Lymphopenia; Macrophage Activation; Macrophages; Male; Middle Aged; Myocytes, Smooth Muscle; Neutrophils; Pulmonary Alveoli; Pulmonary Fibrosis; SARS-CoV-2; Thrombosis
PubMed: 34671353
DOI: 10.3389/fimmu.2021.735922