Diffuse alveolar hemorrhage in immunocompetent patients: Etiologies and prognosis revisited

Prost, Nicolas de; Parrot, Antoine; Cuquemelle, E.; Picard, C.; Antoine, Martine; Fleury-Feith, J; Mayaud, C; Boffa, Jean‐Jacques; Fartoukh, Muriel; Cadranel, Jacques

doi:10.1016/j.rmed.2012.03.015

Cited by 86 publications

(69 citation statements)

References 65 publications

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“…The differential diagnosis of DAH may be classified immunologically by the immunofluorescence or electron microscopic findings or histologically by the data on lung biopsy. Alveolar hemorrhage (AH) may be often associated with an organizing pneumonia consisting of intra-alveolar plugs of loose, organizing fibroblastic connective tissue reminiscent of the bronchiolitis obliterans organizing pneumonia (BOOP) pattern (5,7,9,15,25,26) . Wegener'granulomatosis (WG) is a systemic granulomatous inflammatory process related to the development of vasculitis on the upper and lower respiratory tract and kidney.…”

Section: Discussionmentioning

confidence: 99%

“…Presence of nodular fibrosis and/or centriacinar emphysema may be found in some cases (16,23,25,26) . The differential diagnosis of IPH also includes cases of vasculitis related to polyarteritis nodosa, Takayasu's arteritis, Behçet's syndrome, sarcoidosis, pulmonary infection, and septic emboli (4,5,7,9,11,15,17,25) . In the present report, the authors reported a case of IPH in an adult male patient referring cough and hemoptysis, after exhaustive clinical, laboratorial and radiologic investigation to exclude other possible causes of AH.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic respiratory failure and cor pulmonale are related to the development of severe fibrosis. Some patients develop repeated episodes of hemoptysis, or persistent dyspnea and anemia (5,11,21,26) . The use of corticosteroids must be considered, but the response is variable (1,3,8,12) .…”

Section: Discussionmentioning

confidence: 99%

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Idiopathic pulmonary hemorrhage: morphology and differential diagnosis. Case report

Cambruzzi¹,

Pêgas²,

Vedana³

2013

J. Bras. Patol. Med. Lab.

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Idiopathic pulmonary hemorrhage (IPH) is a rare cause of alveolar hemorrhage (AH) with unknown etiology that primarily affects children. The process has a variable clinical progression, and its diagnosis is established after excluding all causes of AH. Herein, the authors report a case of IPH in an adult male patient referring cough and hemoptysis. The conventional radiography computed tomography imaging identified zones of consolidation and areas of ground-glass attenuation in the lower lobes and lingula. Forced spirometry, bronchoscopy, and laboratorial tests yielded normal results. Several alveolar hemosiderin-laden macrophages were identified on bronchoalveolar lavage and lung biopsy. Thus, the histopathological findings associated with clinical data were compatible with IPH.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Idiopathic pulmonary hemorrhage: morphology and differential diagnosis. Case report

Cambruzzi¹,

Pêgas²,

Vedana³

2013

J. Bras. Patol. Med. Lab.

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“…Affected patients typically present with hemoptysis, anemia and pulmonary infiltration on chest radiographs (CXR). DAH is a severe syndrome with a reported in-hospital mortality of 20-50% (1,2). Providing early appropriate treatment for the underlying cause of DAH is very important for preventing progressive acute respiratory failure.…”

Section: Introductionmentioning

confidence: 99%

“…In a study of 116 patients with DAH, 13 subjects (11.2%) exhibited unilateral infiltration on CXR (2). However, the clinical aspects of unilateral DAH are not well known.…”

Section: Introductionmentioning

confidence: 99%

Diffuse Alveolar Hemorrhage with Predominantly Right-sided Infiltration Resulting from Cardiac Comorbidities

et al. 2015

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Objective Radiographic findings in patients with diffuse alveolar hemorrhage (DAH) are usually diffuse and bilateral, although they may occasionally be unilateral. The clinical aspects of predominantly unilateral DAH are not well known. Therefore, our objective was to describe the clinical characteristics of predominantly right-sided DAH. Methods We retrospectively reviewed data for 460 bronchoalveolar lavage fluid (BALF) samples collected between January 2009 and July 2013. Patients who presented with increasingly hemorrhagic BALF were diagnosed with DAH, and unilateral predominance was determined based on the degree of infiltration on chest radiographs. Results The records of 54 patients with DAH were evaluated. The leading etiology was pulmonary congestion due to heart failure (n=15). The radiographs showed right-sided infiltration in 18 patients (33%), leftsided infiltration in six patients (11%) and bilateral infiltration in 30 patients (56%). Predominantly rightsided DAH was often caused by pulmonary congestion resulting from heart failure (10 of 18 patients). A multivariate logistic regression analysis revealed a previous history of cardiovascular disease to be the only significant predictor of right-sided DAH (OR 13.1, 95% CI 2.9-95.4). Conclusion Predominantly right-sided DAH is frequently caused by pulmonary congestion resulting from heart failure and is significantly related to comorbidities with cardiovascular disease.

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Unilateral diffuse alveolar haemorrhage with microscopic polyangiitis: A case report

Kim

Kang

Seo

et al. 2023

Respirology Case Reports

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Diffuse alveolar haemorrhage (DAH) is a life‐threatening condition caused by widespread damage to the small pulmonary vessels. Common chest imaging findings in patients with DAH show bilateral diffuse airspace opacities. DAH complicating antineutrophil cytoplasmic antibody (ANCA)‐associated vasculitis, including microscopic polyangiitis, should be considered as a differential diagnosis in patients with progressive dyspnea, reduced haemoglobin levels, and alveolar opacities on chest imaging. We report the case of a 78‐year‐old woman who presented with unilateral DAH, severe dyspnea, and anaemia. DAH was confirmed using bronchoalveolar lavage. Laboratory test results, including ANCA, positive anti‐myeloperoxidase antibody, and negative anti‐proteinase 3, led to a diagnosis of microscopic polyangiitis. Rituximab and methylprednisolone were administered. The patient's symptoms, laboratory test results, and chest radiography findings improved after the initiation of treatment. This case highlights the importance of prompt recognition of clinical symptoms and signs, including dyspnea and anaemia, for the diagnosis of DAH.

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Diffuse alveolar hemorrhage in immunocompetent patients: Etiologies and prognosis revisited

Abstract: Arbitrary classification of DAH in four etiologic groups gives the opportunity to underline distinct presentations and outcomes of various causes of DAH.

Cited by 86 publications

References 65 publications

Idiopathic pulmonary hemorrhage: morphology and differential diagnosis. Case report

Idiopathic pulmonary hemorrhage: morphology and differential diagnosis. Case report

Diffuse Alveolar Hemorrhage with Predominantly Right-sided Infiltration Resulting from Cardiac Comorbidities

Unilateral diffuse alveolar haemorrhage with microscopic polyangiitis: A case report

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