Dieulafoy??s Lesion of the Bronchus

Rennert, Douglas; Gharagozloo, Farid; Schwartz, Arnold M.; Margolis, Marc; Tempesta, Barbara; Wu, Jang‐Yen

doi:10.1097/pcr.0b013e31805d09e2

Cited by 6 publications

(4 citation statements)

References 15 publications

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“…Most of the cases were reported from Asia (38 patients) [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], followed by Europe (23 patients) [3,4,[25][26][27][28][29][30][31][32][33][34][35][36][37], North America (seven patients) [38][39][40][41][42][43][44], Oceania (two patients) [5,45], and the country of origin was not reported for three patients (Fig. 2) [46].…”

Section: Continent and Country Of Originmentioning

confidence: 99%

Bronchial Dieulafoy’s disease: a retrospective analysis of 73 cases

Qian

Wei

et al. 2019

BMC Pulm Med

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Background Bronchial Dieulafoy’s disease (BDD) is a rare disease that is known to be a cause of hemorrhage. The characteristics of this disease are still unknown. The present study describes the disorder based on a review of the world’s literature, emphasizing the diagnostic and therapeutic views. Methods A comprehensive research of BDD of the PubMed, Google Scholar, and Web of Science databases was performed. The following data were collected: patient characteristics; chest imaging, bronchoscopy, vascular angiography, and histopathologic examination findings; and treatment rendered. Results 73 cases of BDD have been reported from 1995 to 2019. Most of the cases occurred in Asia (52.1%), followed by Europe (31.5%). Chest imaging findings were non-specific. The main bronchoscopy finding was a nodular or protruding lesion (60.9%). 19 patients underwent bronchoscopic biopsies, 17 had bleeding, and 6 died. Four patients were successfully shown to have vascular malformations under mucosal protrusion by endobronchial ultrasound scan (EBUS). Vascular angiography mainly showed tortuous, dilated bronchial arteries. Vascular angiography mainly showed tortuous, dilated bronchial arteries. The arterial supply was mainly provided by bronchial arteries (48 cases) and the pulmonary circulation (4 cases). The lesions were mainly located in the right bronchus (53 cases). Selective bronchial artery embolization (BAE) was attempted in 38 patients and 20 patients underwent lobectomies. Emergency resection was performed in 15 patients, all of whom survived and had no recurrent hemoptysis. Conclusions Massive hemoptysis was the common manifestation of BDD. Vascular angiography and EBUS is a very useful examination before biopsy. BAE may be used in stable patients, or patients who cannot tolerate surgery, while surgical resection should be considered in patients who are unstable, patients with uncontrolled hemoptysis, or following BAE failure. Electronic supplementary material The online version of this article (10.1186/s12890-019-0863-1) contains supplementary material, which is available to authorized users.

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Section: Continent and Country Of Originmentioning

confidence: 99%

Bronchial Dieulafoy’s disease: a retrospective analysis of 73 cases

Qian

Wei

et al. 2019

BMC Pulm Med

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“…In addition, 43.1% of the 88 patients were previously associated with other respiratory diseases. BDD may be related to chronic airway inflammatory injury or bronchial artery stretching and dilation caused by pulmonary tuberculosis [ 3 , 6 – 8 , 14 , 20 , 29 , 33 , 39 , 42 , 48 ], pneumonia [ 5 , 12 , 23 , 24 ] and bronchiectasis [ 5 , 16 , 23 , 27 , 52 , 57 ].…”

Section: Discussionmentioning

confidence: 99%

“…36 patients received chest X-ray [ 2 , 3 , 6 – 8 , 10 – 17 , 19 , 24 , 30 , 32 , 33 , 36 , 39 , 41 – 43 , 49 , 56 , 60 ]. 78 patients received chest CT [ 2 , 4 , 5 , 7 – 12 , 14 – 20 , 22 – 37 , 39 – 49 , 51 – 60 ]. The imaging manifestations are mainly inflammatory changes and ground glass shadows.…”

Section: Discussionmentioning

confidence: 99%

“…The imaging findings of this patient reported here are mainly lung consolidation and atelectasis; Due to lack of specificity and sensitivity, it is not the first choice for diagnosis of BDD. 82 patients underwent bronchoscopy, of which 26 patients underwent bronchoscopic biopsy [ 3 , 5 , 8 , 10 – 12 , 15 – 18 , 20 , 23 , 24 , 29 , 36 – 38 , 45 , 48 , 49 , 52 , 57 , 61 ], and 18 patients (22%) had severe hemoptysis complications [ 3 , 5 , 10 , 16 – 18 , 20 , 23 , 24 , 29 , 36 , 37 , 45 , 48 , 49 , 52 , 57 , 61 ], and 10 patients died (12.2%) (Table 3 ) [ 3 , 5 , 16 , 23 , 24 , 29 , 45 , 49 , 52 , 61 ]; Microscopically, the main manifestations were small (about 2–7 mm in diameter), no pulsatile, smooth nodules or mucosal protrusions, white caps on the surface, and some nodules may appear with active bleeding and blood clots in the bronchus; In some cases, the abnormal blood vessels in the submucosa present twisting and earthworm like dilation, sometimes presenting purple nodules [ 27 ]. Because of intra bronchial hemorrhage and blood clots, it is difficult to find small mucosal protrusions, or the mucosal protrusions are located below the subsegmental bronchus and cannot be found through conventional bronchoscopy.…”

Section: Discussionmentioning

confidence: 99%

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A case of bronchial Dieulafoy disease and literature review

Shi

Wang

et al. 2023

J Cardiothorac Surg

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Objective Bronchial Dieulafoy's disease (BDD) is a rare disease that causes massive hemoptysis. This paper reports a case of BDD treated surgically. At the same time, we summarize the data of BDD patients reported in domestic and foreign literature to improve the understanding, diagnosis and treatment of this disease. Methods A case of BDD with hemoptysis during bronchoscopy was reported. In addition, we searched for "bronchial Dieulafoy disease" through Pubmed, Web of Science, CNKI and Wanfang databases, covering the literature related to BDD that was definitely diagnosed or highly suspected from January 1995 to December 2021, and summarized the clinical characteristics, chest imaging, bronchoscopic manifestations, angiographic characteristics, pathological characteristics, treatment and outcome of patients. Results The patient was a 68 year old male. Tracheoscopy revealed nodular and mass like changes in the basal segment of the left lower lobe, which appeared massive hemorrhage when touching the surface. The computed tomography angiophy of the bronchial artery confirmed that the branches of the left bronchial artery were tortuous and dilated, and then the left lower lobe of the lung was resected. During the operation, 3 thick tortuous nutrient artery vessels were sent out from the descending aorta, and 1 thick tortuous nutrient artery was sent out from the autonomic arch. All of them were ligated and cut. The pathology after the operation was in accordance with BDD; The patient did not have hemoptysis after discharge and is still under follow-up. The database identified 65 articles from January 1995 to December 2021. After removing repeated reports, meetings, incomplete information and nursing literature, 60 articles were included to report 88 cases of BDD. BDD can occur at all ages, with a male to female ratio of about 1.6:1. It mainly starts with hemoptysis, and can also be seen due to cough, infection, and respiratory failure; Inflammatory changes such as pulmonary patch shadow, exudation shadow and ground glass shadow of pulmonary hemorrhage were more common in chest imaging; The diagnosis of BDD is mainly based on the bronchoscopy, bronchial angiography and pathological findings of surgical or autopsy specimens. Bronchoscopic findings were mostly non pulsating, smooth nodular or mucosal processes. Bronchial angiography mainly showed tortuous dilatation of bronchial artery, and the lesions were mainly located in the right bronchus, more from the bronchial artery; Diagnosis depends on pathology, showing submucosal expansion of bronchus or abnormal artery rupture and bleeding; 54 cases underwent selective bronchial artery embolization, 39 cases underwent pulmonary lobectomy, 66 cases improved, and 10 cases died (all of them were caused by massive hemorrhage during bronchoscopic biopsy). Conclusion BDD is rare, but may cause fatal massive hemoptysis. Bronchial angiography is considered to be an effective method to diagnose BDD. Since pathological biopsy may lead to fatal bleeding, the necessity of pathological diagnosis remains controversial. Interventional and surgical treatment plays an important role in patients with cough accompanied by massive hemoptysis.

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A case report and review of literature of Dieulafoy's disease of bronchus

Zhou

Chen

et al. 2019

Medicine

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Rationale: Dieulafoy's lesions are characterized by the presence of a dysplastic artery in the submucosa, most frequently associated with gastrointestinal hemorrhage. They are rarely identified in the bronchial submucosa and can cause massive or fatal hemoptysis Patient concerns: The patient was a 62-year-old male farmer with intermittent hemoptysis of approximately 2 years duration and a definite diagnosis could not be established. Diagnosis: A thorax-computed tomography at our hospital revealed that the bronchus of left lower lobe was narrowed with associated local atelectasis, and lung cancer was suspected. A bronchoscopy showed a slit-like stenosis of the left lower lobe, swollen and smooth mucosa, and a significantly wider subsection carina. Interventions: A fatal hemorrhage occurred during biopsy and, rescue and resuscitation measures were immediately taken. A double-lumen endotracheal intubation was implanted and single-lung ventilation was started to maintain oxygenation. Hemoptysis completely stopped after bronchial artery embolization. Outcomes: The patient eventually died of disseminative intravascular coagulation and multiple organ failure. Bronchial arteriography and subsequent autopsy confirmed Dieulafoy's disease of the bronchus. Lessons: In cases with recurrent unexplained hemoptysis, where CT chest or thoracic radiography show no abnormalities, pulmonologist should suspect a bronchial Dieulafoy's disease and avoid blindly performing bronchoscopy guided biopsy, which may result in fatal hemoptysis.

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Dieulafoy??s Lesion of the Bronchus

Cited by 6 publications

References 15 publications

Bronchial Dieulafoy’s disease: a retrospective analysis of 73 cases

Bronchial Dieulafoy’s disease: a retrospective analysis of 73 cases

A case of bronchial Dieulafoy disease and literature review

A case report and review of literature of Dieulafoy's disease of bronchus

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