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Cast of the left bronchial tree
A 59-year old woman presented with hemoptysis of thick blood clots and fever of two days duration. Her medical history included sarcoidosis for which she was on chronic steroids. Computed tomography imaging revealed stage IV sarcoidosis with diffuse cystic and fibrotic changes bilaterally, worse in...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Taylor & Francis
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735318/ https://www.ncbi.nlm.nih.gov/pubmed/31528293 http://dx.doi.org/10.1080/20009666.2019.1635839 |
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author | Oudah, Marwa Sandhu, Hargeet Sissoho, Fattoumata Sabath, Bruce |
author_facet | Oudah, Marwa Sandhu, Hargeet Sissoho, Fattoumata Sabath, Bruce |
author_sort | Oudah, Marwa |
collection | PubMed |
description | A 59-year old woman presented with hemoptysis of thick blood clots and fever of two days duration. Her medical history included sarcoidosis for which she was on chronic steroids. Computed tomography imaging revealed stage IV sarcoidosis with diffuse cystic and fibrotic changes bilaterally, worse in the right lung. She underwent bronchoscopy to attempt to localize a source but none was clearly found; no biopsies were performed. Immediately post-procedure she developed massive hemoptysis with hypoxia leading to cardiopulmonary arrest. She was intubated and stabilized with the spontaneous cessation of her bleeding. Immediate angiography revealed no active extravasation, but localized embolization was performed on the right main and right accessory bronchial arteries because these appeared hypertrophied and irregular. Two days later, she again developed spontaneous massive hemoptysis leading to cardiopulmonary arrest. Manual ventilation through the endotracheal tube became impossible. Immediate bronchoscopy identified a blood clot extending from the main carina into the left main stem bronchus. This was removed with a cryoprobe and ventilation could then be achieved easily. Examination of the blood clot demonstrated it to be a cast of the proximal left bronchial tree. Despite the return of spontaneous circulation via resuscitative efforts, the patient developed acute respiratory distress syndrome and later expired. |
format | Online Article Text |
id | pubmed-6735318 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Taylor & Francis |
record_format | MEDLINE/PubMed |
spelling | pubmed-67353182019-09-16 Cast of the left bronchial tree Oudah, Marwa Sandhu, Hargeet Sissoho, Fattoumata Sabath, Bruce J Community Hosp Intern Med Perspect Clinical Imaging A 59-year old woman presented with hemoptysis of thick blood clots and fever of two days duration. Her medical history included sarcoidosis for which she was on chronic steroids. Computed tomography imaging revealed stage IV sarcoidosis with diffuse cystic and fibrotic changes bilaterally, worse in the right lung. She underwent bronchoscopy to attempt to localize a source but none was clearly found; no biopsies were performed. Immediately post-procedure she developed massive hemoptysis with hypoxia leading to cardiopulmonary arrest. She was intubated and stabilized with the spontaneous cessation of her bleeding. Immediate angiography revealed no active extravasation, but localized embolization was performed on the right main and right accessory bronchial arteries because these appeared hypertrophied and irregular. Two days later, she again developed spontaneous massive hemoptysis leading to cardiopulmonary arrest. Manual ventilation through the endotracheal tube became impossible. Immediate bronchoscopy identified a blood clot extending from the main carina into the left main stem bronchus. This was removed with a cryoprobe and ventilation could then be achieved easily. Examination of the blood clot demonstrated it to be a cast of the proximal left bronchial tree. Despite the return of spontaneous circulation via resuscitative efforts, the patient developed acute respiratory distress syndrome and later expired. Taylor & Francis 2019-09-05 /pmc/articles/PMC6735318/ /pubmed/31528293 http://dx.doi.org/10.1080/20009666.2019.1635839 Text en © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of Greater Baltimore Medical Center. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Clinical Imaging Oudah, Marwa Sandhu, Hargeet Sissoho, Fattoumata Sabath, Bruce Cast of the left bronchial tree |
title | Cast of the left bronchial tree |
title_full | Cast of the left bronchial tree |
title_fullStr | Cast of the left bronchial tree |
title_full_unstemmed | Cast of the left bronchial tree |
title_short | Cast of the left bronchial tree |
title_sort | cast of the left bronchial tree |
topic | Clinical Imaging |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735318/ https://www.ncbi.nlm.nih.gov/pubmed/31528293 http://dx.doi.org/10.1080/20009666.2019.1635839 |
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