Dieulafoy’s Disease of the Lung: A Potential Disaster for the Bronchoscopist

Löschhorn, Christoph; Nierhoff, Norbert; Mayer, Ruedi; Zaunbauer, Wolfgang; Neuweiler, Jörg; Knoblauch, A

doi:10.1159/000088059

Cited by 37 publications

(38 citation statements)

References 19 publications

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“…Among the 12 cases of Dieulafoy's disease reported in the literature, five were described in smokers who had no associated comorbidity [22][23][24][25][26][27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Cryptogenic haemoptysis in smokers: angiography and results of embolisation in 35 patients

Menchini¹,

Rémy‐Jardin²,

Faivre³

et al. 2009

European Respiratory Journal

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The aim of the present study was to describe angiographic findings and embolisation results in smokers with haemoptysis.We retrospectively reviewed the clinical data and angiographic findings from 35 patients with smoking-related bronchopulmonary disease and no associated comorbidity, who were referred for embolisation for mild (n56), moderate (n514) and severe (n515) haemoptysis. Spirometric classification subdivided our population into: 16 patients with chronic bronchitis but no airflow limitation; and 19 patients with chronic obstructive pulmonary disease (COPD) (stage I: n512; stage II: n55; stage III: n52).Bronchoscopy depicted focal submucosal vascular abnormalities in three patients and only endobronchial inflammation in 32 (91%) patients. Bronchial artery angiography revealed moderate (n518) or severe (n510) hypervascularisation in 28 (80%) patients, and normal vascularisation in seven (20%). No statistically significant difference was observed between the angiographic findings and the severity of COPD, tobacco consumption or the amount of bleeding. Cessation of bleeding was obtained by embolisation in 29 out of the 34 technically successful procedures (85%), requiring surgery in three out of five patients with recurrence. Follow-up (mean duration 7 yrs) demonstrated no recurrence of bleeding in 32 (94%) out of 34 patients and excluded late endobronchial malignancy.Smokers with various stages of COPD severity may suffer from haemoptysis that is efficiently treatable by endovascular treatment.

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“…Among the 12 cases of Dieulafoy's disease reported in the literature, five were described in smokers who had no associated comorbidity [22][23][24][25][26][27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Cryptogenic haemoptysis in smokers: angiography and results of embolisation in 35 patients

Menchini¹,

Rémy‐Jardin²,

Faivre³

et al. 2009

European Respiratory Journal

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“…2 A Dieulafoy's lesion describes what is essentially a histologically normal vessel 3 that has an abnormally large diameter, maintaining a constant width of 1-3 mm. 2,3 It runs a tortuous course within the submucosa 3,8,12 and, typically, the lesion protrudes through a small mucosal defect varying from 2-5 mm, 3 which has fibrinoid necrosis at its base.…”

Section: Pathologymentioning

confidence: 99%

“…3,8,10,19 There are cases in the literature of newborns being affected, 5 while rare, this could support the suggestion that these lesions are in fact congenital in nature. 2,5,8,12 Interestingly, it has been observed from case histories that a large proportion of patients presenting with rupture are already hospitalised. This has led to the suggestion of stress injury and predilection for the infirm.…”

Section: Aetiologymentioning

confidence: 99%

Dieulafoy's lesion: current trends in diagnosis and management

Baxter

Aly

2010

annals

288

372

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Ann R Coll Surg Engl 2010; 92: 548-554 548The incidence of acute gastrointestinal bleeding ranges from 50-150 per 100,000 of the population each year. It is caused by peptic ulcers and oesophageal or gastroduodenal erosions in almost 80% of patients.1 Obscure gastrointestinal bleeding is reported to account for up to 5% of all gastrointestinal (GI) haemorrhages. It is defined as overt or occult bleeding from a source that cannot be readily determined by standard investigations, such as barium studies and endoscopic investigation. The source is often difficult to locate because the pathology is anatomically inaccessible, small, or subtle. Dieulafoy's lesion is one of the causes of obscure gastrointestinal bleeding that could result in treacherous and life-threatening gastrointestinal haemorrhage. 2,3A Dieulafoy's lesion, also termed 'calibre persistent artery', 2 is a relatively rare, but potentially life-threatening, cause of haemorrhage from the gastrointestinal tract. It is difficult to determine its true incidence in the general population accurately as they are silent until presentation and, even then, it can pose a diagnostic challenge. They are believed to account for only 1-2% of acute GI bleeding, [3][4][5] but are arguably under-recognised rather than being truly rare. The lack of awareness about the Dieulafoy's lesion contributes to its 'rarity', increase in morbidity, and also the previously reported mortality of up to 80% associated with this lesion.6 Rare or not, the precarious nature of the presentation make it necessary to include them in differential diagnosis of any acute GI haemorrhage. The aim of this article is to present an up-to-date review of literature on Dieulafoy's lesion and the recent trends in its diagnosis, treatment and prognosis. Materials and MethodsUsing Medline, a literature search was performed for papers published in English, using the text words 'Dieulafoy'(s)' and 'gastrointestinal bleeding'. All retrieved papers which were relevant to the study were analysed and the findings are summarised in this review. Overall, 159 Dieulafoy's lesion: current trends in diagnosis and management M Baxter, EH AlyLaparoscopic Colorectal Surgery and Training Unit, Aberdeen Royal Infirmary, Aberdeen, UK ABSTRACT BACKGROUND Dieulafoy's lesion is a relatively rare, but potentially life-threatening, condition. It accounts for 1-2% of acute gastrointestinal (GI) bleeding, but arguably is under-recognised rather than rare. Its serious nature makes it necessary to include it in the differential diagnosis of obscure GI bleeding. The aim of this study was to review the current trends in the diagnosis and management of Dieulafoy's lesion. MATERIALS AND METHODS Using Medline, a literature search was performed for articles published in English, using the search words 'Dieulafoy'(s)' and 'gastrointestinal bleeding'. All retrieved papers were analysed and the findings are summarised in this review. RESULTS There is no consensus on the treatment of Dieulafoy's lesions. Therapeutic endoscopy can control t...

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“…Very few cases have been reported in English medical literature. 3,4 The small number of cases may be partly due to the fact that it is difficult to detect the lesion bronchoscopically, and the lesion may be missed even when several bronchoscopies are done, as in this case.…”

Section: Discussionmentioning

confidence: 98%

“…If a lesion is detected between bleeding exacerbations, a biopsy can result in catastrophic hemorrhage. 3 Experience regarding its treatment is limited to a few case reports. Surgical resection in a few cases and selective embolization in others have been used as treatments.…”

Section: Introductionmentioning

confidence: 99%

Endobronchial Argon Plasma Coagulation for Treatment of Dieulafoy Disease

Dalar

Sökücü²,

Özdemir³

et al. 2014

Respir Care

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Dieulafoy disease of the bronchus is a rare condition. A 28-y-old male patient with recurrent exacerbations of hemoptysis (producing up to 300 mL) over the previous 4 y was admitted to our hospital following an acute episode. A 3-mm sessile lesion covered with somewhat ulcerated smooth mucosa was detected at the distal end of the left main bronchus, at the entrance to the upper lobe bronchus. Bleeding was controlled by argon plasma coagulation, and total coagulation of the lesion was also therapeutic. The patient has been followed for 2 y with no further bleeding. In the very few reported cases of Dieulafoy disease, surgical resection and selective embolization were the treatments used. Endobronchial treatment has not been described before as a therapeutic approach. We emphasize that argon plasma coagulation can be a treatment option in such cases.

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Dieulafoy’s Disease of the Lung: A Potential Disaster for the Bronchoscopist

Cited by 37 publications

References 19 publications

Cryptogenic haemoptysis in smokers: angiography and results of embolisation in 35 patients

Cryptogenic haemoptysis in smokers: angiography and results of embolisation in 35 patients

Dieulafoy's lesion: current trends in diagnosis and management

Endobronchial Argon Plasma Coagulation for Treatment of Dieulafoy Disease

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