Pulmonary Capillaritis and Hemorrhage

Imoto, Elaine M.; Lombard, Charles; Sachs, David P.L.

doi:10.1378/chest.96.4.927

Cited by 19 publications

(2 citation statements)

References 5 publications

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“…Diffuse alveolar haemorrhage presents with three possible histopathologic patterns: pulmonary capillaritis, most frequently encountered in granulomatosis with polyangiitis, bland pulmonary haemorrhage and DAD due to drugs or inhalation of toxic chemicals [ 84 ].…”

Section: Resultsmentioning

confidence: 99%

Management of acute respiratory failure in interstitial lung diseases: overview and clinical insights

et al. 2018

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BackgroundInterstitial lung diseases (ILDs) are a heterogeneous group of diseases characterized by widespread fibrotic and inflammatory abnormalities of the lung. Respiratory failure is a common complication in advanced stages or following acute worsening of the underlying disease. Aim of this review is to evaluate the current evidence in determining the best management of acute respiratory failure (ARF) in ILDs.MethodsA literature search was performed in the Medline/PubMed and EMBASE databases to identify studies that investigated the management of ARF in ILDs (the last search was conducted on November 2017).ResultsIn managing ARF, it is important to establish an adequate diagnostic and therapeutic management depending on whether the patient has an underlying known chronic ILD or ARF is presenting in an unknown or de novo ILD. In the first case both primary causes, such as acute exacerbations of the disease, and secondary causes, including concomitant pulmonary infections, fluid overload and pulmonary embolism need to be investigated. In the second case, a diagnostic work-up that includes investigations in regards to ILD etiology, such as autoimmune screening and bronchoalveolar lavage, should be performed, and possible concomitant causes of ARF have to be ruled out.Oxygen supplementation and ventilatory support need to be titrated according to the severity of ARF and patients’ therapeutic options. High-Flow Nasal oxygen might potentially be an alternative to conventional oxygen therapy in patients requiring both high flows and high oxygen concentrations to correct hypoxemia and control dyspnea, however the evidence is still scarce. Neither Non-Invasive Ventilation (NIV) nor Invasive Mechanical Ventilation (IMV) seem to change the poor outcomes associated to advanced stages of ILDs. However, in selected patients, such as those with less severe ARF, a NIV trial might help in the early recognition of NIV-responder patients, who may present a better short-term prognosis. More invasive techniques, including IMV and Extracorporeal Membrane Oxygenation, should be limited to patients listed for lung transplant or with reversible causes of ARF.ConclusionsDespite the overall poor prognosis of ARF in ILDs, a personalized approach may positively influence patients’ management, possibly leading to improved outcomes. However, further studies are warranted.

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Section: Resultsmentioning

confidence: 99%

Management of acute respiratory failure in interstitial lung diseases: overview and clinical insights

et al. 2018

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“…Melanoma, 8 renal cell cancer 9 and carcinoids are deemed vascular tumours of malignant nature that have high bleeding risk. Hypersensitivity pneumonitis and vasculitis, 10 due to their highly inflammatory nature were thought to be of high bleeding risk despite being non‐malignant conditions.…”

Section: Introductionmentioning

confidence: 99%

Using cryobiopsy with Radial EBUS in high‐bleeding‐risk, peripheral pulmonary lesions (PPL): description of cases and technique

Herath

2023

Respirology Case Reports

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Cryobiopsy is an emerging tool in the diagnosis of peripheral pulmonary lesions (PPL) and becoming an important tool in the toolbox. Anecdotally the data on cryobiopsy use in the lung was extrapolated from the use of transbronchial cryobiopsy (TBCB) in Interstitial Lung disease (ILD). Similar to ILD data, cryobiopsy in PPL also provided larger tissue compared to forceps biopsies. Yet, unlike TBCB in ILD, the safety profile for cryobiopsy in PPL seems much more favourable, yet the number of publications on cryobiopsy in PPL remains sparse. Some PPL, both malignant and non‐malignant are considered to be of a high bleeding risk due to vascularity of the tumour and/or inflammation of the blood vessels and surrounding tissue. The use of cryobiopsy and the risk of bleeding in this type of PPL have not been described. This paper describes four patients with PPL, undergoing cryobiopsy with radial EBUS for suspected lung cancer, and later diagnosed to have a PPL, deemed to be of a high bleeding risk. The use of cryobiopsy with radial ultrasonic examination for the vasculature of the PPL, bronchial blocker use, and airway protection as well as an expert team preserved the safety of the procedure.

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Alveolar Diseases

2006

Diffuse Lung Diseases

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Although the etiology and pathogenesis are unknown, the lung damage is thought to be caused by the release of toxic oxygen species and proteases by polymorphonuclear neutrophils Mean age at onset is 50 years. Both sexes are equally affected and there is no correlation with tobacco smoking There are no known risk factors CLINICAL FEATURES The onset is acute and the most common presenting symptoms are cough (100%), dyspnea (80-100%) and fever. Patients often report a prodromal flu-like illness (joint and muscle pain, fever, chills and malaise) Physical examination reveals tachypnea and peripheral cyanosis. In 50% of cases fine rales can be heard throughout the lung fields All patients have reduced DLCO and a restrictive pattern. Moderate to severe hypoxemia, at times refractory to oxygen therapy, rapidly ensues. Rapid progression to respiratory failure similar to acute respiratory distress syndrome (ARDS) is common Vourlekis JS. Acute interstitial pneumonitis. Case series and review of the literature. Medicine 2000, 79: 369 PATHOLOGY The histologic features of AIP are those of diffuse alveolar damage (DAD): • Acute (exudative) phase, rarely biopsied: hyaline membranes, an expression of acute epithelial damage, line the alveolar walls. The alveolar septa show edema and varying amounts of acute and chronic inflammatory infiltrate. Thromboses of small and medium-size arterioles are common • Organizing (proliferative) phase: proliferation of myofibroblasts that migrate from the interstitium to the alveolar spaces: the hyaline membranes (A) are resorbed and organized within the alveolar septa, which become thickened (). Proliferation of hyperplastic type II pneumocytes restores the alveolar epithelium • Chronic (fibrotic) phase: dense fibrosis with possible distortion of lung architecture Definition Etiology and pathogenesis Epidemiology Risk factors History Physical findings Basic lesions Pulmonary function tests Diffuse Lung Diseases Maffessanti & Dalpiaz AIP ☯ Diffuse (alveoli and alveolar septa) Histopathologic differential diagnoses: • DAD associated with infections: granulomas, viral inclusions, necrotic foci, abscesses; identification of the microorganism with special stains • DAD superimposed on UIP (accelerated UIP): associated with the characteristic UIP pattern • DAD due to other causes: not idiopathic but secondary to other causes (shock, trauma, physical or chemical causes, etc.) • OP: predominantly intraalveolar foci of fibroblastic organization, intense inflammatory infiltrate, bronchiolar involvement (not constant)

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Pulmonary Capillaritis and Hemorrhage

Cited by 19 publications

References 5 publications

Management of acute respiratory failure in interstitial lung diseases: overview and clinical insights

Management of acute respiratory failure in interstitial lung diseases: overview and clinical insights

Using cryobiopsy with Radial EBUS in high‐bleeding‐risk, peripheral pulmonary lesions (PPL): description of cases and technique

Alveolar Diseases

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