Endobronchial Changes in Chronic Pulmonary Venous Hypertension

Ohmichi, Mitsuhide; Tagaki, S; Nomura, Naohiro; Tsunematsu, Kazunori; Suzuki, Akira

doi:10.1378/chest.94.6.1127

Cited by 35 publications

(21 citation statements)

References 8 publications

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“…One previously published report of a patient with idiopathic PVOD documented intense hyperaemia of lobar and segmental bronchi with bright red longitudinal streaks at bronchoscopy, postulated to be due to submucosal vasodilatation in bronchial walls [16]. Our patient displayed similar but more extensive bronchoscopic abnormalities, which can be explained by the reverse flow and drainage into visibly dilated bronchial veins from occluded and congested pulmonary veins, comparable to other causes of pulmonary venous hypertension [17].…”

Section: Discussionsupporting

confidence: 72%

Sarcoidosis-related pulmonary veno-occlusive disease presenting with recurrent haemoptysis

Jones¹,

Dawson²,

Jenkins³

et al. 2009

Eur Respir J

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Section: Discussionsupporting

confidence: 72%

Sarcoidosis-related pulmonary veno-occlusive disease presenting with recurrent haemoptysis

Jones¹,

Dawson²,

Jenkins³

et al. 2009

Eur Respir J

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“…Bronchoscopic airway inspection may show hyperaemia of the lobar and segmental bronchi due to vascular engorgement [63]. The appearance could be compared to that in cardiac disease, such as mitral stenosis, where chronic pulmonary venous hypertension leads to engorgement and dilatation of the bronchial venous plexuses and veins [64]. RABILLER et al [9] have compared results of BAL from eight PVOD patients and 11 idiopathic PAH patients.…”

Section: Balmentioning

confidence: 99%

Pulmonary veno-occlusive disease

Montani¹,

Price²,

Dorfmüller³

et al. 2008

Eur Respir J

272

250

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Pulmonary veno-occlusive disease (PVOD) is currently classified as a subgroup of pulmonary arterial hypertension (PAH) and accounts for 5-10% of cases initially considered to be idiopathic PAH. PVOD has been described as idiopathic or complicating other conditions, including connective tissue diseases, HIV infection, bone marrow transplantation, sarcoidosis and pulmonary Langerhans cell granulomatosis. PVOD shares broadly similar clinical presentation, genetic background and haemodynamic characteristics with PAH. Compared to PAH, PVOD is characterised by a higher male/female ratio, higher tobacco exposure, lower arterial oxygen tension at rest, lower diffusing capacity of the lung for carbon monoxide, and lower oxygen saturation nadir during the 6-min walk test. High-resolution computed tomography (HRCT) of the chest can be suggestive of PVOD in the presence of centrilobular ground-glass opacities, septal lines and lymph node enlargement. Similarly, occult alveolar haemorrhage is associated with PVOD. A noninvasive diagnostic approach using HRCT of the chest, arterial blood gases, pulmonary function tests and bronchoalveolar lavage could be helpful for the detection of PVOD patients and in avoiding high-risk surgical lung biopsy for histological confirmation. PVOD is characterised by a poor prognosis and the possibility of developing severe pulmonary oedema with specific PAH therapy. Lung transplantation is the treatment of choice. Cautious use of specific PAH therapy can, however, be helpful in some patients.KEYWORDS: Alveolar haemorrhage, BMPR2, computed tomography, diffusing capacity of the lung for carbon monoxide, pulmonary arterial hypertension, pulmonary veno-occlusive disease P ulmonary arterial hypertension (PAH) is a severe condition characterised by elevated pulmonary artery pressure leading to right heart failure and death [1,2]. Pulmonary veno-occlusive disease (PVOD) is classified as a subgroup of PAH and accounts for 5-10% of histological forms of cases initially considered to be idiopathic PAH. Even though the first welldocumented case of PVOD was described .70 yrs ago, the characteristics and pathophysiology of this disease remain poorly understood [3,4]. While pulmonary vascular pathology of idiopathic or familial PAH is characterised by a major remodelling of small pre-capillary pulmonary arteries with typical plexiform and/or thrombotic lesions, PVOD preferentially affects the post-capillary venous pulmonary vessels [5,6]. Despite this anatomical histological difference, PVOD has a very similar clinical presentation to PAH but is characterised by a worse prognosis and the possibility that severe pulmonary oedema can develop with specific PAH therapy, justifying the importance of diagnosing this disease. A definitive diagnosis of PVOD requires histological analysis of a lung sample [7,8]; however, surgical lung biopsy is a high-risk procedure in these patients and the development of a less invasive diagnostic approach would be preferable [9][10][11]. The present manuscript will summa...

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“…Thus, in pulmonary venous stenosis the drainage systems of both lung circulations are blocked. Typical consequences include distended pleural-hilar bronchial veins, alveolar haemorrhage, a friable endobronchial mucosa, a reduced lymphatic drainage, interstitial pulmonary oedema, enlarged hilar lymph nodes, enlarged lymph vessels and sometimes pleural effusions [77][78][79][80][81][82]. To keep the lung an optimal gas-exchanging system, the pulmonary arterial blood flow is also affected, with redistribution of the pulmonary arterial blood flow towards regions with lower vascular resistance [83][84][85][86][87].…”

Section: Pathophysiologymentioning

confidence: 99%

“…As in other cases with massive haemoptysis, clinical management includes early endotracheal intubation with large-bore tubes in an intensive care unit setting, early bronchoscopy for localisation of the bleeding side and early endobronchial therapy to protect the nonbleeding side. The endobronchial changes with dilatation of the dense submucosal venous plexus can often be seen in bronchoscopy and the alveolar haemorrhage will result in a bloody bronchoalveolar lavage or, if occult, in an increased number of siderophages in the cell differentiation [82]. Due to the dense network between the pulmonary and bronchial circulation, extensive collaterals between both circulations may develop, with the possible occurrence of secondary bronchial and pulmonary venous varices in the long run.…”

Section: Haemoptysis and Other Clinical Symptoms And Signs Caused By mentioning

confidence: 99%

Haemoptysis due to pulmonary venous stenosis

Braun¹,

Platzek²,

Zöphel³

et al. 2014

Eur Respir Rev

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Haemoptysis is a potentially life-threatening condition with the need for prompt diagnosis. In about 10-20% of all cases the bleeding source remains unexplained with the standard diagnostic approach. The aim of this article is to show the necessity of widening the diagnostic approach to haemoptysis with consideration of pulmonary venous stenosis as a possible cause of even severe haemoptysis and haemoptoe.A review of the literature was performed using the Medline/PubMed database with the terms: ''pulmonary venous stenosis'', ''pulmonary venous infarction'' and ''haemoptysis''. Further references from the case reports were considered.58 case reports and case collections about patients with haemoptysis due to pulmonary venous stenosis were detected. This review gives an overview about the case reports and discusses the underlying pathophysiology and the pros and cons of different imaging techniques for the detection of pulmonary venous stenosis.Several conditions predispose to the obstruction of the mediastinal pulmonary veins. Clinical findings are unspecific and may be misleading. Pulmonary venous stenosis can be detected using several imaging techniques, yet three-dimensional magnetic resonance-angiography and three-dimensional contrastenhanced computed tomography are the most appropriate. Pulmonary venous stenosis should be considered in patients with haemoptysis. @ERSpublications Pulmonary venous stenosis should be considered in haemoptysis and is best diagnosed using CT or MRI venography http://ow.ly/tMPFP

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Endobronchial Changes in Chronic Pulmonary Venous Hypertension

Cited by 35 publications

References 8 publications

Sarcoidosis-related pulmonary veno-occlusive disease presenting with recurrent haemoptysis

Sarcoidosis-related pulmonary veno-occlusive disease presenting with recurrent haemoptysis

Pulmonary veno-occlusive disease

Haemoptysis due to pulmonary venous stenosis

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