Radiological aspects of diffuse alveolar haemorrhage

Cortese, Giancarlo; Nicali, Roberta; Placido, R.; Gariazzo, G.; Anrò, P.

doi:10.1007/s11547-008-0229-x

Cited by 40 publications

(17 citation statements)

References 13 publications

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“…High-resolution computerised tomography (HRCT) should be considered if further imaging is required to aid in the diagnosis. DAH is associated with features ranging from localised ground-glass opacification to more extensive consolidation with air bronchograms on HRCT, even in the presence of a normal CXR (21,22). Despite the improved diagnostic yield there are still no specific changes on HRCT that point towards DAH, opacities can be diffuse or more focal in nature (20,23).…”

Section: Diagnosis Of Diffuse Alveolar Haemorrhagementioning

confidence: 99%

Diffuse Alveolar Haemorrhage in ANCA-associated Vasculitis

et al. 2013

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Diffuse alveolar haemorrhage (DAH) is a serious complication of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). A literature review was performed to ascertain the diagnostic features, treatment, and outcome of this rare but serious condition. Haemoptysis and dyspnoea are common but nonspecific features. Chest radiography is usually abnormal, and high-resolution computerised tomographic scanning is more sensitive. Increased uptake of inhaled carbon monoxide and reduced clearance of C 15 O on lung function testing is suggestive of intra-alveolar blood. Fiberoptic bronchoscopy and bronchoalveolar lavage are useful when a super-added infection is suspected. Concurrent renal disease is common and contributes to the morbidity and mortality. Treatment should be individualised, and it is based on glucocorticoid and cyclophosphamide induction with azathioprine maintenance. The role of plasmapheresis is unclear, and is currently being evaluated. Patients are at risk of disease and treatment-related long-term complications. Ongoing research into the most efficacious therapeutic regimens associated with the least side effects is especially important.

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Section: Diagnosis Of Diffuse Alveolar Haemorrhagementioning

confidence: 99%

Diffuse Alveolar Haemorrhage in ANCA-associated Vasculitis

et al. 2013

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“…It can have a mortality exceeding 50% in the intensive care setting and is traditionally associated with haemoptysis, although this may be absent in a significant proportion of patients [5]. Radiological features include a non-specific diffuse infiltrative opacification pattern on chest X-ray and ground-glass opacities on CT in acute bleeding [6]. It carries a wide differential diagnosis including vasculitis, infection, drugs, acute respiratory distress syndrome and heart failure [3].…”

Section: Diffuse Alveolar Haemorrhagementioning

confidence: 99%

Leptospirosis as an important differential of pulmonary haemorrhage on the intensive care unit: a case managed with VV-ECMO

et al. 2020

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Background: Leptospirosis is a potentially fatal zoonosis. It can cause a wide range of symptoms, including diffuse alveolar haemorrhage which occurs in a minority of cases but carries a mortality of over 70%. These patients may present with severe acute respiratory failure. The differential diagnosis for diffuse alveolar haemorrhage is broad whereas prompt diagnosis and treatment can be lifesaving. Case presentation: A 20-year-old previously fit and well trout farm worker presented with a 3-day history of malaise, fevers, diarrhoea, vomiting and jaundice. He developed haemoptysis, severe headaches, neck stiffness and photophobia on the day of emergency admission. He was anaemic and thrombocytopenic. Anuric acute kidney injury (urea 32, creat 507) required immediate haemofiltration. In view of progressive respiratory failure with fourquadrant lung infiltrates on imaging, he was given broad spectrum antibiotics and pulsed methylprednisolone empirically, in case of a vasculitic pulmonary-renal presentation. He was intubated within 48 h of admission. Despite attempted protective ventilatory management, he remained hypoxaemic and developed pneumomediastinum. He was retrieved to a specialist cardiorespiratory intensive care unit on femoro-femoral mobile VV-ECMO. Three days from admission, results showed positive Leptospira IgM and real-time PCR. Serial bronchoscopies showed old and fresh clots, but not the classical progressive late red tinge of the returned lavage fluid. After eight days, VV-ECMO was weaned, he was extubated three days later, and made a full recovery. At 9 months follow-up, he was clinically better, with resolution of the CT scan findings and near normal lung function, albeit with low normal gas transfer. Conclusions: Leptospirosis is a rare but important differential to be considered in diffuse alveolar haemorrhage presenting to the ICU, especially in young males. A thorough history for occupational or recreational risk factors may offer the diagnostic clue. Most patients recover fully with antibiotics. However, resulting acute severe respiratory failure can ensue. In this situation, early consideration for respiratory ECMO support offers time for clearance of endobronchial clot, parenchymal recovery, and prevention of ventilator-induced lung injury. Steroids have no clear evidence but may be used to avoid delay in treating suspected vasculitic or autoimmune causes of diffuse alveolar haemorrhage.

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“…Echocardiography may aid in the diagnosis of cardiogenic pulmonary oedema. High-resolution CT is superior to CXR in detecting DAH by the presence of localised ground-glass opacification or more extensive consolidation with air bronchograms, and is particularly valuable in cases of suspected DAH with normal CXR findings 42 43. There is no distribution of opacities specific to DAH, which may either be patchy or uniform 44 45…”

Section: Diagnostic Evaluation Of Dahmentioning

confidence: 99%

Pulmonary-renal syndrome: a life threatening but treatable condition

West

Arulkumaran

Ind

et al. 2013

Postgraduate Medical Journal

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Pulmonary renal syndrome (PRS) describes the occurrence of renal failure in association with respiratory failure, characterised by autoimmune-mediated rapidly progressive glomerulonephritis (RPGN) and diffuse alveolar haemorrhage (DAH), respectively. PRS is associated with significant morbidity and mortality, and prompt diagnosis and treatment significantly improve outcomes. Prompt diagnosis of PRS requires a high index of suspicion, as clinical features are non-specific, and immunological testing aids the diagnosis in many cases. The diagnostic evaluation of DAH and RPGN is outlined in the context of the important differential diagnoses. The commonest causes of PRS include antineutrophil cytoplasm antibody (ANCA)-associated vasculitis and antiglomerular basement membrane disease. As such, more emphasis has been placed on these two conditions in addition to an overview of the less common causes of PRS. We provide a practical review of the diagnostic evaluation, current treatment strategies and clinical outcomes of PRS for renal, respiratory and general physicians.

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Radiological aspects of diffuse alveolar haemorrhage

Cited by 40 publications

References 13 publications

Diffuse Alveolar Haemorrhage in ANCA-associated Vasculitis

Diffuse Alveolar Haemorrhage in ANCA-associated Vasculitis

Leptospirosis as an important differential of pulmonary haemorrhage on the intensive care unit: a case managed with VV-ECMO

Pulmonary-renal syndrome: a life threatening but treatable condition

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