Introduction:Pulmonary hemorrhage(PHm)is a life-threatening complication that can occur after catheter-based interventions in patients with pulmonary vein stenosis(PVS).Inhaled racemic epinephrine(iRE)and tra-nexamic ...Introduction:Pulmonary hemorrhage(PHm)is a life-threatening complication that can occur after catheter-based interventions in patients with pulmonary vein stenosis(PVS).Inhaled racemic epinephrine(iRE)and tra-nexamic acid(iTXA)have been used in other conditions,but a standardized approach in PVS has not been described.We aimed to describe the current management of PHm after PVS catheter-based interventions.Methods:We present a retrospective review of episodes of PHm from July 2022 to February 2024.PHm was defined as frank blood suctioned from the endotracheal tube including blood-tinged secretions and>3%decrease in saturations and/or ventilatory changes with or without acute chest X-ray changes.Each individual episode of PHm was considered a separate event.Incidence was calculated based on the total number of PVS interventions during the study period.Results:Eleven episodes of PHm were identified out of 108 PVS interventions,resulting in an incidence of 10.2%.Five(45.5%)had primary PVS,and seven(63.6%)had bilateral PVS.The median age at PHm was 23 months(3-91 months).Four episodes were treated with iRE,five with both iRE and iTXA,and two with only iTXA due to a history of suprasystemic right ventricular pressures.Median time on mechanical ventila-tion after PHm was 24 h(15-72 h)and a median ICU stay of 2 days(1-8 days).Hemostasis was achieved in all events.There were no adverse events after iTXA,however,transient hypertension was observed after iRE which was dose-related.Conclusions:The implementation of a standardized protocol for the treatment of PHm in PVS has the potential to improve procedural planning,has a wider availability of medications,and greater awareness by the providers involved,possibly leading to earlier detection of PHm and appropriate treatment.展开更多
Background Pulmonary hemorrhage (PH) is a life-threatening respiratory complication of extremely low-birth-weight infants (ELBWIs).However,the risk factors for PH are controversial.Therefore,the purpose of this study ...Background Pulmonary hemorrhage (PH) is a life-threatening respiratory complication of extremely low-birth-weight infants (ELBWIs).However,the risk factors for PH are controversial.Therefore,the purpose of this study was to analyze the perinatal risk factors and short-term outcomes of PH in ELBWIs.Methods This was a retrospective cohort study of live born infants who had birth weights that were less than 1000 g,lived for at least 12 hours,and did not have major congenital anomalies.A logistic regression model was established to analyze the risk factors associated with PH.Results There were 168 ELBWIs born during this period.A total of 160 infants were included,and 30 infants were diagnosed with PH.Risk factors including gestational age,small for gestational age,intubation in the delivery room,surfactant in the delivery room,repeated use of surfactant,higher FiO2 during the first day,invasive ventilation during the first day and early onset sepsis (EOS) were associated with the occurrence of PH by univariate analysis.In the logistic regression model,EOS was found to be an independent risk factor for PH.The mortality and intraventricular hemorrhage rate of the group of ELBWIs with PH were significantly higher than those of the group of ELBWIs without PH.The rates of periventricular leukomalacia,moderate-to-severe bronchopulmonary dysplasia and severe retinopathy of prematurity,and the duration of the hospital stay were not significantly different between the PH and no-PH groups.Conclusions Although PH did not extend hospital stay or increase the risk of bronchopulmonary dysplasia,it increased the mortality and intraventricular hemorrhage rate in ELBWIs.EOS was the independent risk factor for PH in ELBWIs.展开更多
Microscopic polyangiitis （MPA） is characterized by an inflammatory process of the vessel walls and is classified according to the smallest vessels involved. Diagnosis is based on clinical manifestations, anti-neutro...Microscopic polyangiitis （MPA） is characterized by an inflammatory process of the vessel walls and is classified according to the smallest vessels involved. Diagnosis is based on clinical manifestations, anti-neutrophil cytoplasmic autoantibody （ANCA） testing, and histology. In this disease, pulmonary hemorrhage is seen in 30% of patients and is associated with an eight-fold increase in mortality. Classically, MPA involves the kidneys and upper and lower respiratory tracts. Due to the perceived risk of increased bleeding secondary to the use of systemic anticoagulation, extra corporeal membrane oxygenation （ECMO） is often not used to treat patients with hemorrhage suffered from MPA. Here we report a case of a 50-year-old woman with MPA that was successfully supported with ECMO.展开更多
Rationale:Dengue fever is a viral infection that is spread through the bites of infected female Aedes mosquitos.It can cause life threatening complications,including dengue haemorrhagic fever(DHF)and dengue shock synd...Rationale:Dengue fever is a viral infection that is spread through the bites of infected female Aedes mosquitos.It can cause life threatening complications,including dengue haemorrhagic fever(DHF)and dengue shock syndrome.Patient concerns:A 15-year-old male presented with fever and petechiae and later developed hemoptysis.Diagnosis:Dengue fever with DHF with diffuse alveolar hemorrhage.Interventions:Invasive ventilation with high positive end expiratory pressure,multiple transfusions of packed red blood cells,fresh frozen plasma,single donor platelets and inotropic support Outcomes:The patient was stabilized and discharged on minimal supplemental oxygen.Lessons:Diffuse alveolar hemorrhage,although very rare,should be considered in a patient with dengue who presents with hemoptysis.The treatment is directed at providing respiratory and circulatory support,and preventing the progression of microcirculation damage.展开更多
Systemic arterial to pulmonary vessel fistulas may develop in the setting of pleural inflammation and/or injury.Bronchial arteries are the most commonly involved vessels,with recruitment often occurring in chronic dis...Systemic arterial to pulmonary vessel fistulas may develop in the setting of pleural inflammation and/or injury.Bronchial arteries are the most commonly involved vessels,with recruitment often occurring in chronic diseases such as tuberculosis and cystic fibrosis.Rarely,transpleural systemic arteries that directly communicate with the pulmonary vasculature may develop in the presence of pleural injury or chronic inflammation.The clinical presentation and management of three cases of transpleural systemic artery to pulmonary vessel fistulas are detailed.Given the atypical imaging appearance of these lesions,there is risk of misdiagnosis of these entities as a pulmonary arteriovenous malformation.Understanding the pathophysiology,complex anatomy,and treatment for these rare vascular malformations is crucial prior to angiographic intervention in order to improve outcomes,avoid misdiagnosis,and prevent inappropriate intervention.展开更多
文摘Introduction:Pulmonary hemorrhage(PHm)is a life-threatening complication that can occur after catheter-based interventions in patients with pulmonary vein stenosis(PVS).Inhaled racemic epinephrine(iRE)and tra-nexamic acid(iTXA)have been used in other conditions,but a standardized approach in PVS has not been described.We aimed to describe the current management of PHm after PVS catheter-based interventions.Methods:We present a retrospective review of episodes of PHm from July 2022 to February 2024.PHm was defined as frank blood suctioned from the endotracheal tube including blood-tinged secretions and>3%decrease in saturations and/or ventilatory changes with or without acute chest X-ray changes.Each individual episode of PHm was considered a separate event.Incidence was calculated based on the total number of PVS interventions during the study period.Results:Eleven episodes of PHm were identified out of 108 PVS interventions,resulting in an incidence of 10.2%.Five(45.5%)had primary PVS,and seven(63.6%)had bilateral PVS.The median age at PHm was 23 months(3-91 months).Four episodes were treated with iRE,five with both iRE and iTXA,and two with only iTXA due to a history of suprasystemic right ventricular pressures.Median time on mechanical ventila-tion after PHm was 24 h(15-72 h)and a median ICU stay of 2 days(1-8 days).Hemostasis was achieved in all events.There were no adverse events after iTXA,however,transient hypertension was observed after iRE which was dose-related.Conclusions:The implementation of a standardized protocol for the treatment of PHm in PVS has the potential to improve procedural planning,has a wider availability of medications,and greater awareness by the providers involved,possibly leading to earlier detection of PHm and appropriate treatment.
文摘Background Pulmonary hemorrhage (PH) is a life-threatening respiratory complication of extremely low-birth-weight infants (ELBWIs).However,the risk factors for PH are controversial.Therefore,the purpose of this study was to analyze the perinatal risk factors and short-term outcomes of PH in ELBWIs.Methods This was a retrospective cohort study of live born infants who had birth weights that were less than 1000 g,lived for at least 12 hours,and did not have major congenital anomalies.A logistic regression model was established to analyze the risk factors associated with PH.Results There were 168 ELBWIs born during this period.A total of 160 infants were included,and 30 infants were diagnosed with PH.Risk factors including gestational age,small for gestational age,intubation in the delivery room,surfactant in the delivery room,repeated use of surfactant,higher FiO2 during the first day,invasive ventilation during the first day and early onset sepsis (EOS) were associated with the occurrence of PH by univariate analysis.In the logistic regression model,EOS was found to be an independent risk factor for PH.The mortality and intraventricular hemorrhage rate of the group of ELBWIs with PH were significantly higher than those of the group of ELBWIs without PH.The rates of periventricular leukomalacia,moderate-to-severe bronchopulmonary dysplasia and severe retinopathy of prematurity,and the duration of the hospital stay were not significantly different between the PH and no-PH groups.Conclusions Although PH did not extend hospital stay or increase the risk of bronchopulmonary dysplasia,it increased the mortality and intraventricular hemorrhage rate in ELBWIs.EOS was the independent risk factor for PH in ELBWIs.
文摘Microscopic polyangiitis （MPA） is characterized by an inflammatory process of the vessel walls and is classified according to the smallest vessels involved. Diagnosis is based on clinical manifestations, anti-neutrophil cytoplasmic autoantibody （ANCA） testing, and histology. In this disease, pulmonary hemorrhage is seen in 30% of patients and is associated with an eight-fold increase in mortality. Classically, MPA involves the kidneys and upper and lower respiratory tracts. Due to the perceived risk of increased bleeding secondary to the use of systemic anticoagulation, extra corporeal membrane oxygenation （ECMO） is often not used to treat patients with hemorrhage suffered from MPA. Here we report a case of a 50-year-old woman with MPA that was successfully supported with ECMO.
文摘Rationale:Dengue fever is a viral infection that is spread through the bites of infected female Aedes mosquitos.It can cause life threatening complications,including dengue haemorrhagic fever(DHF)and dengue shock syndrome.Patient concerns:A 15-year-old male presented with fever and petechiae and later developed hemoptysis.Diagnosis:Dengue fever with DHF with diffuse alveolar hemorrhage.Interventions:Invasive ventilation with high positive end expiratory pressure,multiple transfusions of packed red blood cells,fresh frozen plasma,single donor platelets and inotropic support Outcomes:The patient was stabilized and discharged on minimal supplemental oxygen.Lessons:Diffuse alveolar hemorrhage,although very rare,should be considered in a patient with dengue who presents with hemoptysis.The treatment is directed at providing respiratory and circulatory support,and preventing the progression of microcirculation damage.
文摘Systemic arterial to pulmonary vessel fistulas may develop in the setting of pleural inflammation and/or injury.Bronchial arteries are the most commonly involved vessels,with recruitment often occurring in chronic diseases such as tuberculosis and cystic fibrosis.Rarely,transpleural systemic arteries that directly communicate with the pulmonary vasculature may develop in the presence of pleural injury or chronic inflammation.The clinical presentation and management of three cases of transpleural systemic artery to pulmonary vessel fistulas are detailed.Given the atypical imaging appearance of these lesions,there is risk of misdiagnosis of these entities as a pulmonary arteriovenous malformation.Understanding the pathophysiology,complex anatomy,and treatment for these rare vascular malformations is crucial prior to angiographic intervention in order to improve outcomes,avoid misdiagnosis,and prevent inappropriate intervention.
