Differenzialdiagnostik der diffusen alveolären Hämorrhagie

Abstract

Diffuse alveolar haemorrhage (DAH) denotes a diffuse intra-alveolar bleeding from small vessels as a result of severe damage of the alveolocapillary membrane of the lungs. These are comparatively rare, but than often life threatening events. The differential diagnosis is broad and comprises immunologic as well as toxic, infectious, hemodynamic, neoplastic and physical causes. DAH may be a manifestation of systemic diseases, as well as a result of an injury restricted to the lungs. The most frequent systemic diseases, that cause DAH are the so-called small vessel vasculititis-microscopic polyangiitis and Wegener's granulomatosis. More rarely Goodpasture's syndrome and systemic lupus erythematosus are causal. Alongside the immunologic processes mainly diseases with increased left-ventricular preload, infections and side effects of drugs have to be kept in mind. This review summarizes the differential diagnostic spectrum and the diagnostic workup of patients with DAH. Because early aggressive treatment can be life-saving, early and aimed diagnostics is essential.

Diffuse alveolar hemorrhage in Wegener′s granulomatosis

“…Most cases of DAH are caused by capillaritis associated with systemic autoimmune diseases such as antineutrophil cytoplasmic antibody-associated vasculitis, antiglomerular basement membrane disease, and systemic lupus erythematosus. [4] Rarely, pulmonary metastasis of angiosarcoma has also been reported as the cause of DAH. [5] Generally speaking, dyspnea, cough, hemoptysis, and new alveolar infiltrates in conjunction with bloody BAL specimens (with numerous erythrocytes and siderophages) establish the diagnosis of diffuse alveolar hemorrhage.…”

Treatment of Diffuse Pulmonary Hemorrhage with Factor VIIa

“…Diffuse pulmonary hemorrhage is a syndrome occurring not only in trauma patients but may be a consequence of severe damage of the alveolocapillary membrane due to autoimmune, toxic, infectious hemodynamic, and other causes [11]. Several reports have focused on the successful use of rFVIIa to control diffuse pulmonary hemorrhage in non-injured patients with autoimmune disorders and after hematopoietic stem-cell transplantation [12][13][14][15][16][17].…”

Vaskulitiden mit pulmonaler Beteiligung

“…Vaskulitiden sind wichtige Ursachen von pulmonalen Blutungen, sowohl als diffuse pulmonale Hämorrhagie als auch als pulmonale Kapillaritis [24]. Neben den oben ausführlich dargestellten Kleingefäßvaskulitiden können bei ungewöhnlichen Verläufen auch andere Vaskulitiden zu Einblutungen führen [25].…”