MH - MASSIVE HEMOPTYSIS-abdul khaliq DEFINITION...

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Unformatted text preview: MASSIVE HEMOPTYSIS-abdul khaliq DEFINITION >200-600 ml/24 hrs Crocco et al. showed that prognosis of medically treated hemoptysis changes drastically when 600 ml of blood is lost in 1 day Massive hemoptysis is seen in 1.5 % of all hemoptysis cases ANATOMY Pulmonary circulation- low pressure 15-20mm HG/ 5-10 mm HG BRONCHIAL CIRCULATION Nutritional source to lung Arise from aorta / intercostal arteries Ant. Spinal artery may arise from the bronchial artery ANATOMY Enter hila - >follow bronchial tree->anastomose freely with each other as plexiform arrangement in peri-bronchial space Extensive submucosal plexus in bronchial wall Beyond the terminal bronchiole anastomose with precapillary pulm. arterioles and veins Arterioles associated with airways are under systemic pressure, they have propensity to bleed when airways are diseased ETIOLOGY TUBERCULOSIS Active tubercular pneumonitis- bronchiolar erosion Rupture of Rasmussens aneurysm (pulm. art) Healed calcified LNE-eroding through bronchial arteries into airway (expectoration of broncholith) Scar carcinoma Development of bronchiectasis Mycetoma formation BRONCHIECTASIS Pathologically it is destruction of the cartilaginous support of bronchial wall and bronchial dilatation owing to parenchymal retraction from alveolar fibrosis ANATOMICAL CHANGES: Bronchial artery hypertrophy Expansion of peribronchial & sub mucosal bronchiolar arteriolar plexus Augmentation of anastomoses with the pulmonary arterial bed FUNGAL INFECTION Mycetoma Fungal pneumonia- invasive fungal infections- common in hematological malignancies- mainly by the Aspergillus Blastomycosis &Histoplasmosis MYCETOMA Preexisting cavity lesions Sarcoidosis, Tuberculosis, Lung abscess, Cavitating carcinoma (squamous carcinoma) Lung abscess , Lung infarction, Bullous emphysema, Bronchiectasis, Fibrobullous disease of rheumatoid arthritis & ankylosing spondylitis MYCETOMA Fungal ball- hyphal elements mixed with necrotic cellular debris, fibrin &mucus Wall of mycetoma cavity is fibrous containing of highly vascular granulation tissue & chronic inflammatory cells The blood vessels lining the cavity are the branches of bronchial artery network MYCETOMA Saprophytic infections Aspergillus fumigatus is the commonest organism other species of aspergillus mucur Hemoptysis occur in 50- 90% of patients with mycetoma MYCETOMA MECHANISMS: Mechanical trauma of the vascular granulation tissue by the movement of the fungal ball in the cavity Vascular injury from aspergillus associated endotoxin Aspergillus related proteolytic activity Vascular damage from a type 3 hypersensitivity reaction Fungal ball Crescent sign Fungal ball LUNG ABSCESS 11-15% of primary lung abscess patients Massive bleeding in 20- 50 % of bleeders Due to necrotizing effect of primary infection and the inflammation that involves pulmonary vasculature MITRAL STENOSIS...
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This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

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MH - MASSIVE HEMOPTYSIS-abdul khaliq DEFINITION...

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