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Monday, 2 December 2013

Hemorrhaging: Pulmonary hemorrhage (P-Hem) - The Symptoms and Diagnosis

Hemorrhaging is also known as bleeding or abnormal bleeding as a result of blood loss due to internal.external leaking from blood vessels or through the skin.
Pulmonary hemorrhage (P-Hem)
Pulmonary hemorrhage is defined  as a acute condition of lung bleeding from the from the upper respiratory tract or the endotracheal tube of the lung with the mortality of 30 to 40%.
Symptoms
1. The onset of P-Hem is characterized by oozing of bloody fluid from the nose and mouth or endotracheal tube with associated rapid worsening of the respiratory status, cyanosis and, in severe cases, shock(7).

2. In the report of 3 cases of enterovirus 71 infection with pulmonary edema or pulmonary hemorrhage as the early clinical manifestation, found that pulmonary edema or pulmonary hemorrhage occurred in the 3 cases with EV71-infected infants. The initial presentation was often nonspecific with fever and vomiting, and sudden appearances of cyanosis, tachypnea, tachycardia, hypertension or hypotension, limb weakness may suggest pulmonary edema or hemorrhage. Excessive fluid resuscitation may deteriorate the illness, on the contrary, fluid restriction and inotropic agents, and early intubation with positive pressure mechanical ventilation may be the proper treatment(8).

3. Etc.

E.3. Diagnosis 
1. The computed tomography (CT) scans and chest radiograph
In the study of the computed tomography (CT) scans and chest radiograph of seven patients with bronchoscopic or pathologically proven cases of pulmonary hemorrhage to determine the appearance and value of each modality, showed that CT revealed the presence and location in all cases while chest radiographs were falsely negative in two cases. The CT pattern was always an alveolar pattern while the pattern was more variable on chest radiographs. By providing better pattern definition than the chest radiographs, CT is the study of choice in detecting the presence of a suspected pulmonary hemorrhage(9).

2. Bronchoalveolar lavage (BAL)
Bronchoalveolar lavage (BAL) is a medical procedure to collect and examine the lung fluid with the use of a bronchoscope, passing through the mouth or nose into the lungs. In the study to investigate the efficacy of bronchoalveolar lavage (BAL) in diagnosing pulmonary hemorrhage  in 51 immunosuppressed patients with new pulmonary infiltrates, showed that Severe pulmonary hemorrhage was ultimately diagnosed in 14 cases, and a mild degree of hemorrhage was found in an additional 19 cases. Thrombocytopenia and invasive fungal infections were statistically associated with severe hemorrhage, as was an increased percentage of alveolar macrophages in the BAL sample(10).

3.  CT-guided transthoracic lung biopsy
Higher rates of complications are significantly found with multiple punctures (pneumothorax risk multiplied by 7.4), longer intra-parenchymal needle tract (5 and 7% higher risk of pneumothorax and hemorrhage for every 1 mm increase in depth), and with smaller lesions (2 and 5% lower risk respectively for pneumothorax and hemorrhage for every 1 cm increase in lesion size). The presence of an interposing rib is associated with a higher rate of hemorrhage(11).

4. Etc.
 
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Sources

(7) http://www.ucsfbenioffchildrens.org/pdf/manuals/29_PulmHemorrhage.pdf 
(8) http://www.ncbi.nlm.nih.gov/pubmed/19099810  
(9) http://www.sciencedirect.com/science/article/pii/089970719390021E
(10) http://www.ncbi.nlm.nih.gov/pubmed/3605828 
(11) http://www.ncbi.nlm.nih.gov/pubmed/22645895