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Ultrasound in Medicine & Biology Aug 2021Induction of pulmonary capillary hemorrhage (PCH) by lung ultrasound (LUS) depends not only on physical exposure parameters but also on physiologic conditions and drug...
Induction of pulmonary capillary hemorrhage (PCH) by lung ultrasound (LUS) depends not only on physical exposure parameters but also on physiologic conditions and drug treatment. We studied the influence of xylazine and clonidine on LUS-induced PCH in spontaneously hypertensive and normotensive rats using diagnostic B-mode ultrasound at 7.3 MHz. Using ketamine anesthesia, rats receiving saline, xylazine, or clonidine treatment were tested with different pulse peak rarefactional pressure amplitudes in 5 min exposures. Results with xylazine or clonidine in spontaneously hypertensive rats were not significantly different at the three exposure pulse peak rarefactional pressure amplitudes, and thresholds were lower (2.2 MPa) than with saline (2.6 MPa). Variations in LUS PCH were not correlated with mean systemic blood pressure. Similar to previous findings for dexmedetomidine, the clinical drug clonidine tended to increase susceptibility to LUS PCH.
Topics: Animals; Antihypertensive Agents; Capillaries; Clonidine; Hemorrhage; Hypertension; Lung; Male; Rats; Rats, Inbred SHR; Rats, Inbred WKY; Ultrasonic Waves; Ultrasonography; Xylazine
PubMed: 33972153
DOI: 10.1016/j.ultrasmedbio.2021.03.033 -
Lung Feb 2013Diffuse alveolar hemorrhage (DAH) represents a syndrome that can complicate many clinical conditions and may be life-threatening, requiring prompt treatment. It is... (Review)
Review
Diffuse alveolar hemorrhage (DAH) represents a syndrome that can complicate many clinical conditions and may be life-threatening, requiring prompt treatment. It is recognized by the signs of acute- or subacute-onset cough, hemoptysis, diffuse radiographic pulmonary infiltrates, anemia, and hypoxemic respiratory distress. DAH is characterized by the accumulation of intra-alveolar red blood cells originating most frequently from the alveolar capillaries. It must be distinguished from localized pulmonary hemorrhage, which is most commonly due to chronic bronchitis, bronchiectasis, tumor, or localized infection. Hemoptysis, the major sign of DAH, may develop suddenly or over a period of days to weeks; this sign may also be initially absent, in which case diagnostic suspicion is established after sequential bronchoalveolar lavage reveals worsening red blood cell counts. The causes of DAH can be divided into infectious and noninfectious, the latter of which may affect immunocompetent or immunodeficient patients. Pulmonary infections are rarely reported in association with DAH, but they should be considered in the diagnostic workup because of the obvious therapeutic implications. In immunocompromised patients, the main infectious diseases that cause DAH are cytomegalovirus, adenovirus, invasive aspergillosis, Mycoplasma, Legionella, and Strongyloides. In immunocompetent patients, the infectious diseases that most frequently cause DAH are influenza A (H1N1), dengue, leptospirosis, malaria, and Staphylococcus aureus infection. Based on a search of the PubMed and Scopus databases, we review the infectious diseases that may cause DAH in immunocompetent patients.
Topics: Dengue; Hemorrhage; Humans; Immunocompetence; Influenza, Human; Lung Diseases; Malaria; Pulmonary Alveoli; Respiratory Tract Infections; Staphylococcal Infections; Syndrome
PubMed: 23128913
DOI: 10.1007/s00408-012-9431-7 -
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 -
Lung Aug 2017Dengue fever is an arboviral disease transmitted to humans through the bites of infected female Aedes mosquitoes. Dengue virus is a member of the Flaviviridae family,... (Review)
Review
Dengue fever is an arboviral disease transmitted to humans through the bites of infected female Aedes mosquitoes. Dengue virus is a member of the Flaviviridae family, and human infection can be caused by any of the four antigenically distinct serotypes (DENV 1-4). The infection has become recognized as the most important and prevalent arboviral disease in humans, endemic in almost 100 countries worldwide. Nearly 3 billion people live in areas with transmission risk. Autochthonous transmission of the virus in previously disease-free areas, increased incidence in endemic areas, and epidemic resurgence in controlled regions could increase the risk of contracting more severe forms of the disease, such as dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS). Symptomatic dengue virus infection can present with a wide range of clinical manifestations, from mild fever to life-threatening DSS. Thoracic complications may manifest as pleural effusion, pneumonitis, non-cardiogenic pulmonary edema, and hemorrhage/hemoptysis. No vaccine is currently available and no specific treatment for dengue fever exists, but prevention and prompt management of complications in patients with DHF can help reduce mortality. This review describes the main clinical, pathological, and imaging findings of thoracic involvement in DHF.
Topics: Aedes; Animals; Biopsy; Dengue Vaccines; Dengue Virus; Diagnosis, Differential; Hemoptysis; Humans; Lung; Predictive Value of Tests; Prognosis; Risk Factors; Severe Dengue; Tomography, X-Ray Computed
PubMed: 28612239
DOI: 10.1007/s00408-017-0021-6 -
British Journal of Haematology Nov 2015Hereditary haemorrhagic telangiectasia is a rare systemic autosomal dominantly inherited disorder of the fibrovascular tissue with a wide variety of clinical... (Review)
Review
Hereditary haemorrhagic telangiectasia is a rare systemic autosomal dominantly inherited disorder of the fibrovascular tissue with a wide variety of clinical manifestations. Diagnosis is based on the clinical Curaçao criteria or molecular genetic testing. Dilated vessels can develop into telangiectases or larger vascular malformations in various organs, calling for an interdisciplinary approach. Epistaxis and gastrointestinal bleeding can result from these vascular defects. Various conservative and interventional treatments have been described for these conditions. However, no optimal therapy exists. Treatment can become especially difficult due to progressive anaemia or when anticoagulant or anti-thrombotic therapy becomes necessary. Screening for pulmonary arteriovenous malformations (PAVM) should be performed in all confirmed and suspected patients. Treatment by percutaneous transcatheter embolotherapy and antibiotic prophylaxis is normally effective for PAVM. Cerebral or hepatic vascular malformations and rare manifestations need to be evaluated on a case-by-case basis to determine the best course of action for treatment.
Topics: Anemia, Iron-Deficiency; Antibiotic Prophylaxis; Anticoagulants; Arteriovenous Malformations; Disease Management; Embolization, Therapeutic; Epistaxis; Fibrinolytic Agents; Gastrointestinal Hemorrhage; Hemostatics; Humans; Hypertension, Pulmonary; Intracranial Arteriovenous Malformations; Liver; Lung; Neovascularization, Pathologic; Signal Transduction; Telangiectasia, Hereditary Hemorrhagic; Thrombophilia; Transforming Growth Factor beta
PubMed: 26205234
DOI: 10.1111/bjh.13606 -
The Journal of International Medical... May 2021Pulmonary haemorrhage is an important complication of leptospirosis. We herein report an uncommon case of severe pulmonary haemorrhage and multiple organ failure caused... (Review)
Review
Pulmonary haemorrhage is an important complication of leptospirosis. We herein report an uncommon case of severe pulmonary haemorrhage and multiple organ failure caused by leptospirosis in a 49-year-old man who was previously healthy. He was a farm worker who was admitted to the hospital because of haemoptysis. He had worked in a paddy field 4 days prior to admission. Chest computed tomography revealed pulmonary haemorrhage, which rapidly deteriorated into haemorrhagic shock and multiple organ failure. Based on the patient's possible history of contact with contaminated water and the DNA sequence of detected in his bronchoalveolar lavage fluid, the patient was diagnosed with pulmonary haemorrhagic leptospirosis. Despite the administration of a fluid bolus, norepinephrine, broad-spectrum antibiotics, and haemostatics, and even with administration of a blood transfusion and extracorporeal life support, the pulmonary haemorrhage could not be controlled effectively. The patient eventually died of haemorrhagic shock. Leptospirosis can be a life-threatening disease despite aggressive treatment, even with extracorporeal life support. Next-generation sequencing can provide important diagnostic clues for patients with atypical leptospirotic symptoms.
Topics: Hemorrhage; Humans; Leptospira; Leptospirosis; Lung Diseases; Male; Middle Aged; Multiple Organ Failure
PubMed: 34044641
DOI: 10.1177/03000605211019665 -
Developmental Period Medicine 2018Introduction: Due to specific anatomy of children are more vulnerable to the carcinogenic effects of ionizing radiation from chest X-rays. Lung ultrasound (LUS) is a...
OBJECTIVE
Introduction: Due to specific anatomy of children are more vulnerable to the carcinogenic effects of ionizing radiation from chest X-rays. Lung ultrasound (LUS) is a validated procedure which can easily be used in diagnosing pathologies of the neonatal lung. However, experimental studies have shown that low frequency ultrasound may induce pulmonary capillary hemorrhage (PCH). Aim of the study: To evaluate the potential relationship between lung ultrasound and pulmonary hemorrhage in very low birth weight infants.
PATIENTS AND METHODS
Patients and methods: We analysed the medical records of very low birth weight infants admitted to our neonatal tertiary centre between 2008 and 2011 (group 1), when CXR was the main procedure used to evaluate the respiratory system, and between 2013 and 2016 (group 2), when LUS became a routine procedure, replacing the chest X-ray.
RESULTS
Results: 297 infants were enrolled in the first group and 286 in the second group, respectively. There was no difference in the frequency of pulmonary hemorrhages between the two groups (p=1). In the first group there was only one episode of PCH and in the second group no PCH was seen. Statistically significant differences were seen in a number of patients with pulmonary hemorrhage risk factors: surfactant administration (p<0.001), mechanical ventilation (p=0.0003), and hemodynamically significant patent ductus arteriosus (p=0.025).
CONCLUSION
Conclusions: Routine lung ultrasound appears to be safe in very low birth weight infants; there were no episodes of pulmonary hemorrhage.
Topics: Female; Hemorrhage; Humans; Infant, Newborn; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Lung; Lung Injury; Male; Patient Safety; Ultrasonography
PubMed: 29641425
DOI: 10.34763/devperiodmed.20182201.7580 -
American Journal of Physiology. Lung... Jul 2004To determine whether increased levels of VEGF disrupt postnatal lung formation or function, conditional transgenic mice in which VEGF 164 expression was enhanced in...
To determine whether increased levels of VEGF disrupt postnatal lung formation or function, conditional transgenic mice in which VEGF 164 expression was enhanced in respiratory epithelial cells were produced. VEGF expression was induced in the lungs of VEGF transgenic pups with doxycycline from postnatal day 1 through 2 and 6 wk of age. VEGF levels were higher in bronchoalveolar lavage fluid (BALF) and lung homogenates of VEGF transgenic mice compared with endogenous VEGF levels in controls. Neonatal mortality was increased by 50% in VEGF transgenic mice. Total protein content in BALF was elevated in VEGF transgenic mice. Surfactant protein B protein expression was unaltered in VEGF transgenic mice. Although postnatal alveolar and vascular development were not disrupted by VEGF expression, VEGF transgenic mice developed pulmonary hemorrhage, alveolar remodeling, and macrophage accumulation as early as 2 wk of age. Electron microscopy demonstrated abnormal alveolar capillary endothelium in the VEGF transgenic mice. In many locations, the endothelium was discontinuous with segments of attenuated endothelial cells. Large numbers of hemosiderin-laden macrophages and varying degrees of emphysema were observed in adult VEGF transgenic mice. Overexpression of VEGF in the neonatal lung increased infant mortality and caused pulmonary hemorrhage, hemosiderosis, alveolar remodeling, and inflammation.
Topics: Aging; Animals; Animals, Newborn; Blood Vessels; Capillaries; Capillary Permeability; Endothelium, Vascular; Hemorrhage; Hemosiderosis; Lung; Lung Diseases; Mice; Mice, Inbred Strains; Mortality; Pulmonary Alveoli; Pulmonary Surfactant-Associated Protein B; Vascular Endothelial Growth Factor A
PubMed: 15033636
DOI: 10.1152/ajplung.00050.2004 -
Journal of Microbiology, Immunology,... Dec 2021Toxocara canis, a source of visceral larva migrans, causes toxocariasis and induces respiratory symptoms. The reasons by which the pulmonary pathological alteration in...
BACKGROUND
Toxocara canis, a source of visceral larva migrans, causes toxocariasis and induces respiratory symptoms. The reasons by which the pulmonary pathological alteration in the lungs infected with T. canis remain unclear.
METHODS
The involvement of the pulmonary pathological alteration by histology, enzyme activity, and Western blot analysis in the lungs of BALB/c mice after the infection of 2000 embryonated eggs.
RESULTS
The pathological effects gradually increased after the infection culminated in severe leukocyte infiltration and hemorrhage from days 4-14 post-inoculation. Gelatin zymography using substrate showed that the relative activity of matrix metalloproteinase (MMP) -9 and MMP-2 significantly increased in T. canis-infected mice. Western blot analysis indicated that the MMPs protein level of fibronectin monomer significantly increased in T. canis-infected mice compared with that in uninfected control. T. canis larvae mainly initiated leukocyte infiltration and hemorrhage in the lungs.
CONCLUSION
These phenomena subsequently induced the activities of MMPs in parallel with the pathological changes in early stage pulmonary inflammation. In conclusion, T. canis larval migration activated the MMPs and caused pulmonary pathogenesis.
Topics: Animals; Fibronectins; Hemorrhage; Larva; Leukocytes; Lung; Male; Matrix Metalloproteinases; Mice; Mice, Inbred BALB C; Toxocara canis; Toxocariasis
PubMed: 32826193
DOI: 10.1016/j.jmii.2020.07.022 -
Annals of Cardiac Anaesthesia 2021Massive pulmonary hemorrhage during pulmonary thromboendarterectomy (PTE) can be managed by a conservative approach with mechanical ventilatory support, positive...
Massive pulmonary hemorrhage during pulmonary thromboendarterectomy (PTE) can be managed by a conservative approach with mechanical ventilatory support, positive end-expiratory pressure, lung isolation, reversal of heparin, and correct of coagulopathy. We present three challenging cases that developed intrapulmonary hemorrhage during/after PTE and managed successfully. The first patient had bleeding from the bronchial artery and right internal mammary collaterals, which was managed by coil-embolization. The second patient had a breach in the blood airway barrier in the right upper lobar segment of the lung, and the repair was done using a surgical absorbable hemostat. The third patient developed reperfusion injury, he was instituted on veno-venous extracorporeal membranous oxygenation, a week later, the patient recovered completely. An algorithm was adopted and modified to our requirements; all the 3 challenging intrapulmonary hemorrhage cases were successfully managed. This algorithm can be used for satisfactory outcomes in patients who suffer intrapulmonary hemorrhage during PTE.
Topics: Chronic Disease; Endarterectomy; Hemorrhage; Humans; Hypertension, Pulmonary; Infant, Newborn; Lung; Male; Pulmonary Artery; Pulmonary Embolism
PubMed: 34269276
DOI: 10.4103/aca.ACA_191_20