Diffuse alveolar hemorrhage secondary to plastic fume exposure: A case report

A 31-year non-smoker man, working in plastic making industry for 12 years presented with cough and streaking hemoptysis for 2 days. Computed tomography (CT) of chest showed patchy ground glass opacities with interlobular septal thickening in bilateral lung parenchyma. Fiber optic bronchoscopy (FOB) was done. Sequential lavage was taken which showed progressively increasing hemorrhagic fluid. His diffusion capacity for carbon monoxide (DLCO) was 38.08 mL/mmHg/Mi (126%) predicted on day 2 of admission, 32.36 ml/mmHg/Mi (106%) predicted on discharge and 39.63 mL/mmHg/Mi (130%) predicted on going back to work. He was diagnosed with plastic fume exposure related pulmonary alveolar hemorrhage.

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Diffuse Alveolar Hemorrhage Caused by Warfarin after Rifampicin Discontinuation

Case Reports in Medicine ◽

10.1155/2019/4917856 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3 ◽

Cited By ~ 4

Author(s):

Takashige Kiyota ◽

Seiji Shiota ◽

Ryosuke Hamanaka ◽

Daisuke Tsutsumi ◽

Takeshi Takakura ◽

...

Keyword(s):

Computed Tomography ◽

High Resolution ◽

Prothrombin Time ◽

Persistent Infection ◽

Warfarin Therapy ◽

Anticoagulant Activity ◽

International Normalized Ratio ◽

Diffuse Alveolar Hemorrhage ◽

Alveolar Hemorrhage ◽

High Resolution Computed Tomography

An 83-year-old man under warfarin therapy presented for assessment of prolonged prothrombin time and cough. High-resolution computed tomography findings of the chest showed diffuse alveolar hemorrhage. His international normalized ratio (INR) was 11.89. He had been treated with rifampicin for a persistent infection, but this had been discontinued about two months before admission. Rifampicin suppresses the anticoagulant activity of warfarin, which can lead to a need for increased doses of warfarin to achieve and maintain a therapeutic INR. More frequent INR monitoring is needed even after discontinuing rifampicin.

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CT Manifestations of Coronavirus Disease 2019 and the Semi-Quantitative Evaluation of Its Clinical Classification

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2021.3683 ◽

2021 ◽

Vol 11 (5) ◽

pp. 1489-1494

Author(s):

Chunhua Li ◽

Guangxiao Tang ◽

Xueyan Liu ◽

Jia Yang ◽

Yanqiu Lu ◽

...

Keyword(s):

Computed Tomography ◽

Lung Injury ◽

Ground Glass Opacity ◽

Lung Damage ◽

Lung Involvement ◽

Clinical Classification ◽

Superior Lobe ◽

Retrospective Nature ◽

Bilateral Lung ◽

Interlobular Septal Thickening

Purpose: To improve the understanding of the manifestations associated with computed tomography (CT) in the context of coronavirus disease 2019 (COVID-19). Methods: An analysis of a retrospective nature was carried out on clinically-based data as well as CT manifestations in 102 patients with a COVID-19 diagnosis who were admitted to our hospital between the 24th of January, 2020 and the 5th of February, 2020. Scoring of CT manifestations was accomplished, and the total score was used to determine the severity of lung injury. Results: Of the 102 patients, 10 had mild COVID-19, 72 had COVID-19 that was classed as moderate, 16 had COVID-19 that was severe, and 4 had COVID-19 that was critically severe. In all, 92 patients developed lung lesions, among whom 85 showed bilateral lung involvement. Superior lobe lesions and lesions in the middle-inner zone of the lung less frequently affected patients who developed moderate COVID-19 as compared to patients who developed severe/critically severe COVID-19 (all P < 0.05). The lesion manifestations included ground-glass opacity shadows (98.9%) and mixed-density shadows with consolidation (45.7%). Lamellar lesions and interlobular septal thickening less frequently affected patients with COVID-19 that was moderate than in patients with COVID-19 that was severe or critically severe (P < 0.05). In terms of COVID-19 that was moderate, severe or critically severe, the average scores associated with CT were 10.68 ± 6.32, 22.31 ± 8.07, and 30.75 ± 1.89 points respectively. A cumulative CT score of ≤ 20 points was the critical point for distinguishing moderate COVID-19 from severe/critically severe COVID-19. Conclusion: With regards to CT manifestations that were associated with COVID-19, certain characteristics were demonstrated and these varied in relation to different classifications of COVID-19. Cumulative CT score could be used to evaluate the clinical classification and degree of lung damage in patients who develop COVID-19.

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A Case of Diffuse Alveolar Hemorrhage Associated with Tegafur plus Uracil and Warfarin Therapy

Clinical Medicine Insights Case Reports ◽

10.4137/ccrep.s8522 ◽

2011 ◽

Vol 4 ◽

pp. CCRep.S8522 ◽

Cited By ~ 1

Author(s):

Masayuki Itoh ◽

Shuji Oh-ishi ◽

Kenji Nemoto ◽

Seitaro Senba ◽

Hideki Adachi ◽

...

Keyword(s):

Myocardial Infarction ◽

Computed Tomography ◽

Lung Cancer ◽

Bronchoalveolar Lavage Fluid ◽

Warfarin Therapy ◽

Lavage Fluid ◽

International Normalized Ratio ◽

Diffuse Alveolar Hemorrhage ◽

Alveolar Hemorrhage ◽

Sequential Samples

A 72-year-old man who received warfarin for myocardial infarction (prothrombin time-international normalized ratio [PT-INR] controlled between 2.2 and 2.5) for 2 years. He developed lung cancer, underwent surgery, and received tegafur plus uracil (UFT) after 1 month. After 2 months, he was admitted for hemoptysis and dyspnea. Chest radiography and computed tomography showed bilateral alveolar infiltration (PT-INR, 8.9). Bronchoalveolar lavage fluid (BALF) disclosed hemorrhagic features in sequential samples. And he was diagnosed with diffuse alveolar hemorrhage (DAH). A known interaction exists between fluoropyrimidines and warfarin. So, they were discontinued, and vitamin K was intravenously administered. One day later, the PT-INR returned to 1.14. The symptoms improved and, alveolar infiltration resolved after 2 weeks. Alveolar hemorrhage may be due to an interaction between UFT and warfarin. When fluoropyrimidines and warfarin are prescribed simultaneously, we recommend that PT-INR should be closely monitored.

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COVID 19, All a Radiologist Needs to Know: A Narrative Review

Current Respiratory Medicine Reviews ◽

10.2174/1573398x16999200727170424 ◽

2020 ◽

Vol 16 ◽

Author(s):

Farzaneh Shobeirian

Keyword(s):

Computed Tomography ◽

Rna Viruses ◽

Imaging Findings ◽

Protective Measures ◽

Infection Transmission ◽

The World ◽

Positive Sense ◽

Global Concern ◽

Interlobular Septal Thickening ◽

Radiologic Characteristics

Background: Coronaviruses are non-segmented enveloped positive-sense single-strand RNA viruses, and COVID-19 is the seventh known coronavirus, infecting humans. Objective: As the COVID-19 continued to spread the world wildly, every radiologist or clinician needs to be familiar with its imaging findings. Methods: In this study, we reviewed available studies to provide a comprehensive statement on COVID-19 imaging findings. Results: Ground-glass opacities, linear opacities, interlobular septal thickening, consolidation, and Crazy-paving patterns are the most frequent findings in computed tomography (CT) of lungs in patients with COVID-19 pneumonia, which are mostly bilateral, multifocal, and peripheral. Staff needs to follow some rules to reduce infection transmission. Conclusion: COVID-19 pneumonia is a new global concern which has many unknown features. In this article, the radiologic characteristics of COVID-19 pneumonia are discussed. We also discussed appropriate protective measures that the radiology team should be aware of.

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Diffuse Alveolar Hemorrhage After Orotracheal Extubation Probably Induced by Sevoflurane Inhalation

Archivos de Bronconeumología (English Edition) ◽

10.1016/j.arbr.2020.12.009 ◽

2021 ◽

Vol 57 (8) ◽

pp. 547-548

Author(s):

Mauro Carvalho Mendonça ◽

João Bettencourt Abreu ◽

Karina Gama

Keyword(s):

Diffuse Alveolar Hemorrhage ◽

Alveolar Hemorrhage

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Negative-pressure-related diffuse alveolar hemorrhage after monitored anesthesia care for vertebroplasty: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02697-6 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Yumin Jo ◽

Jagyung Hwang ◽

Jieun Lee ◽

Hansol Kang ◽

Boohwi Hong

Keyword(s):

Case Report ◽

Airway Obstruction ◽

Negative Pressure ◽

Diffuse Alveolar Hemorrhage ◽

Alveolar Hemorrhage ◽

Unknown Etiology ◽

Anesthesia Care ◽

Monitored Anesthesia Care ◽

X Ray ◽

Chest X Ray

Abstract Background Diffuse alveolar hemorrhage (DAH) is a rare, life-threatening condition that can present as a spectrum of nonspecific symptoms, ranging from cough, dyspnea, and hemoptysis to severe hypoxemic respiratory failure. Perioperative DAH is frequently caused by negative pressure pulmonary edema resulting from acute airway obstruction, such as laryngospasm, although hemorrhage itself is rare. Case presentation This case report describes an unexpected hemoptysis following monitored anesthesia care for vertebroplasty. A 68-year-old Asian woman, with a compression fracture of the third lumbar vertebra was admitted for vertebroplasty. There were no noticeable events during the procedure. After the procedure, the patient was transferred to the postanesthesia care unit (PACU), at which sudden hemoptysis occurred. The suspected airway obstruction may have developed during transfer or immediate arrive in PACU. In postoperative chest x-ray, newly formed perihilar consolidation observed in both lung fields. The patients was transferred to a tertiary medical institution for further evaluation. She diagnosed with DAH for hemoptysis, new pulmonary infiltrates on chest x-ray and anemia. The patient received supportive care and discharged without further events. Conclusions Short duration of airway obstruction may cause DAH, it should be considered in the differential diagnosis of postoperative hemoptysis of unknown etiology.

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