Introduction: The aim of reporting these two cases is to present visual evidence by bronchoscopy of the origin of haemoptysis in two elite breath-hold divers. Case reports: Two male elite breath-hold divers of similar physical characteristics presented to our clinic after performing dives of up to 75 and 59 meters of seawater depth for 2:30 and 2:35 (minutes:seconds) respectively. Both patients presented with haemoptysis. Lung ultrasound was performed. The first patient had crackles on chest auscultation, overt pulmonary oedema clinically and 90 ultrasound lung comets. The second patient had no oedema or crackles, but presented with 20 ultrasound lung comets. Video bronchoscopy was performed which showed traces of blood coming from all three segments of the right upper lobe in both patients. The rest of the airways and lungs were intact. Conclusions: These finding suggest that the apical parts of the lungs are the most prone to deep-dive induced damage. The precise mechanism of lung barotrauma and haemoptysis in breath-hold divers remains to be elucidated. These findings may be of importance for a better understanding of the underlying pathology of haemoptysis.
Sažetak. Cilj: Prikazati spontano, netraumatsko perirenalno krvarenje (Wünderlich sindrom) kao prvu manifestaciju karcinoma bubrega te dijagnostički i terapijski postupak kod takvog pacijenta. Prikaz slučaja: Pacijentica stara 37 godina došla je na hitni medicinski trakt s intenzivnim, naglo nastalim bolovima u lijevom lumbalnom predjelu abdomena; uredno je mokrila, negirala traumu i nije imala makrohematuriju. Zbog općeg lošeg stanja pacijentica je poslana na hitnu višeslojnu kompjutoriziranu tomografiju (engl. Multi-slice computed tomography, MSCT) abdomena i zdjelice na kojoj je utvrđena inhomogena formacija u gornjem polu lijevog bubrega uz zaključak radiologa da se radi o perirenalnom krvarenju, najvjerojatnije uzrokovanog angiomiolipomom. Urolog se odlučio za hitni operacijski zahvat koji uključuje djelomičnu nefrektomiju lijevog bubrega te evakuaciju hematoma. Patohistološki pregled uputio je na karcinom bubrega kromofobnog tipa koji je uzrokovao krvarenje. Pacijentica se redovito kontrolira, nema znakova recidiva. Zaključak: Wünderlich sindrom je rijetka, potencijalno životno ugrožavajuća manifestacija karcinoma bubrega koja zahtijeva hitni operacijski zahvat. MSCT abdomena i zdjelice je radiološka metoda izbora za akutni abdominalni/lumbalni bol u hemodinamski nestabilnog pacijenta.
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