Pneumonectomy for unremitting hemoptysis in unilateral absence of pulmonary artery

Bekoe, Seth; Pellegrini, Ronald V.; Dimarco, Ross F.; Grant, Kathleen J.; Woelfel, George F.

doi:10.1016/0003-4975(93)91108-y

Cited by 23 publications

(16 citation statements)

References 7 publications

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“…Haemoptysis is most often inconsequential and results from hypertrophied collateral vessels [1,3,7]. Venules P-H. KUO ruptured because of the higher circulation pressures in the affected lung can cause haemoptysis of a potentially lethal magnitude [8,9]. Bronchiectasis has been reported in some patients, but its pathogenesis and association with recurrent infections remain unclear [5].…”

Section: Discussionmentioning

confidence: 99%

“…Embolization and ligation of the numerous collateral vessels have been attempted unsuccessfully to control bleeding [8]. In view of the fact that the affected lung in UAPA does not contribute to ventilation, it has been recommended that if the patient is fit, pneumonectomy should be performed when massive haemoptysis occurs [9]. Aggressive treatment is indicated when haemoptysis, haematemesis, recurrent infection or pulmonary hypertension become intractable.…”

Section: Discussionmentioning

confidence: 99%

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A patient with haemoptysis and a smaller right lung

Kuo¹,

Wu²,

Lee³

1996

Eur Respir J

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A A p pa at ti ie en nt t w wi it th h h ha ae em mo op pt ty ys si is s a an nd d a a s sm ma al ll le er r r ri ig gh ht t l lu un ng g Case historyA 41-year-old businessman was admitted to National Taiwan University Hospital for evaluation of a 2-week history of haemoptysis productive of 50-100 mL of fresh blood daily. The patient stated that haemoptysis had first occurred 10 yrs earlier, had lasted for about 1 month and had spontaneously subsided. Both episodes of haemoptysis were preceded by flu-like symptoms. There was no past history of epistaxis, exertional dyspnoea, or loss of body weight.Physical examination revealed a well-developed man in no distress. His blood pressure was 112/70 mmHg, pulse 96 beats . min -l and respiratory rate 22 breaths . min -1 . There was a slightly decreased chest wall excursion, and breath sounds in the right hemithorax. No audible bruits were heard over the chest. Heart sounds were regular, without murmurs. No clubbing, cyanosis, telangiectasia or oedema were noted. Arterial blood gases in room air showed: a pH of 7.41; arterial carbon dioxide tension (Pa,CO 2 ) of 4.9 kPa (36.5 mmHg); and arterial oxygen tension (Pa,O 2 ) of 13.1 kPa (98.3 mmHg). The sputum was negative for acid-fast bacilli, fungi and malignant cells. An electrocardiogram was normal. Echocardiography showed normal cardiac size and good left ventricular contractility, with no evidence of congenital cardiac lesions or pulmonary hypertension. On bronchoscopy, no endobronchial lesion or definite site of bleeding was found.Imaging studies, including a posteroanterior (PA) chest radiograph ( fig. l), and computed tomography (CT) scan at the level of the aorticopulmonary window ( fig. 2) are shown.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A patient with haemoptysis and a smaller right lung

Kuo¹,

Wu²,

Lee³

1996

Eur Respir J

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“…Van der Werf et al [15]describe a patient with nonperfused left lung, due to unilateral pulmonary vein atresia and favorable outcome after pneumonectomy. Bekoe et al [16]also recommends pneumonectomy for hemoptysis in a nonperfused lung, caused by unilateral absence of pulmonary artery.…”

Section: Discussionmentioning

confidence: 99%

Takayasu Disease with Predominant Pulmonary Involvement

Elsässer¹,

Solèr²,

Bolliger³

et al. 2000

Respiration

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We report a case of Takayasu’s arteritis with predominant pulmonary involvement, which led eventually to complete obliteration of the right pulmonary artery. Subsequently, cavitation and chronic inflammation developed in the nonperfused right lung. A right pneumonectomy was performed to control the infectious process, leading to functional improvement and better control of the underlying immunologic disorder.

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“…While Hemoptysis can be chronic and self-limited, cases of massive hemoptysis have been reported in the literature. (5,8,9) Diagnosing UAPA can be difficult, but important clues are present in chest radiographs. The chest radiograph of patients with UAPA typically shows asymmetric lung fields, with an ipsilateral small hemithorax holding a hyperlucent lung.…”

Section: Financial Ormentioning

confidence: 99%

“…(2,12,13) Hemoptysis may be treated with embolization, lobectomy, or pneumonectomy. (8,9) Embolization is a relatively safe procedure with few side effects and is a viable alternative to pneumonectomy in patients experiencing hemoptysis. (8) Severe infections may require lobectomy or pneumonectomy, and any pulmonary surgery in a patient with UAPA may be complicated by the presence of systemic collaterals.…”

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confidence: 99%

Unilateral Absence of a Pulmonary Artery : A Rare Disorder With Variable Presentation

H¹

2015

jemds

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Unilateral absence of a pulmonary artery (UAPA) is a rare condition with an estimated prevalence of 1 in 200,000 young adults. Most commonly, UAPA occurs in conjunction with cardiovascular abnormalities such as tetralogy of Fallot or cardiac septal defects, but it can also occur in an isolated manner. Patients with isolated UAPA can remain asymptomatic into late adulthood but usually report symptoms such as dyspnea or chest pain or suffer from hemoptysis or recurrent infections. Diagnosis can be difficult due to the rarity of the condition and its nonspecific presentation. We present a case of a 60-year-old female who presented with history of chronic cough and was found to have UAPA. Typical findings on CT were discussed. The exact embryologic cause of UAPA is a matter of debate and is likely different in left-vs. right-sided UAPA. In both cases, however, altered development of a sixth aortic arch segment is thought to result in a ductal origin to a pulmonary artery that leads to the proximal interruption of that vessel when the ductal tissue regresses at the time of birth. (4) Distal intrapulmonary branches of the affected artery usually remain intact and can be supplied by collateral vessels from bronchial, intercostal, internal mammary, subdiaphragmatic, subclavian, or even coronary arteries. (5,6) Patients with isolated UAPA can present in a variety of ways. A 2002 review of 108 cases of UAPA revealed a median age of presentation of 14 years. (3) The combination of chest pain, pleural effusion, and recurrent infections was present in 37% of patients, while dyspnea or exercise intolerance was present in 40% of patients. Other, Competing Interest: None. Submission 21-04-2015, Peer Review 22-04-2015, Acceptance 31-10-2015, Published 12-11-2015 Pulmonary hypertension was found in 44% of patients that were tested for the disorder. HOW TO CITE THIS ARTICLE: Financial orHemoptysis occurred in about 20% of patients, and high-altitude pulmonary edema was seen in approximately 10% of patients. (3) Seven deaths were noted in the case series and included mortality from massive pulmonary hemorrhage, right heart failure, respiratory failure, pulmonary hypertension, and high-altitude pulmonary edema. Only 14 of 108 patients with isolated UAPA were asymptomatic at the time of their diagnosis and throughout variable follow-up. (3) At the time of our patient's presentation, he reported dyspnea at rest and exercise intolerance. UAPA could definitely be a cause of his dyspnea, and it should be noted that his left lung received 32% of total ventilation on his ventilation perfusion scan but no detectable perfusion, resulting in a large amount of dead space.Pulmonary hypertension could also be a cause for the patient's dyspnea, and indeed, the patient's main pulmonary artery was enlarged, measuring 3.7 cm on his CT pulmonary angiogram (Figure2). However, that study showed no signs of secondary right heart strain. An echocardiogram was ordered but not performed before the patient was lost to follow-up. Other possible c...

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Pneumonectomy for unremitting hemoptysis in unilateral absence of pulmonary artery

Cited by 23 publications

References 7 publications

A patient with haemoptysis and a smaller right lung

A patient with haemoptysis and a smaller right lung

Takayasu Disease with Predominant Pulmonary Involvement

Unilateral Absence of a Pulmonary Artery : A Rare Disorder With Variable Presentation

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