Hemoptysis is defined as coughing out blood.Definition, etiology,pathogenesis,diagnostic evaluation and management has been discussed in this power point presentation
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Hemoptysis is defined as coughing out blood.Definition, etiology,pathogenesis,diagnostic evaluation and management has been discussed in this power point presentation
This presentation covers the methodology of evaluating CTEPH (chronic thromboembolic pulmonary hypertension) case. It starts from the basic concepts of Pulmonary hypertension.
ALL THE QUESTIONS ARE HAVING VERY STANDARD ANSWERS FROM THE STANDARD BOOKS)
REF : ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE.
COMPREHENSIVE IMAGE BASED REVIEW OF PATHOLOGY BY SONI .
GARG & GUPTA PATHOLOGY REVIEW & GENETICS.
Trio of Rheumatic Mitral Stenosis, Right Posterior Septal Accessory Pathway a...Ramachandra Barik
A 57-year-old male presented with recurrent palpitations. He was diagnosed with rheumatic mitral stenosis, right posterior septal accessory pathway and atrial flutter. An electrophysiological study after percutaneous balloon mitral valvotomy showed that the palpitations were due to atrial flutter with right bundle branch aberrancy. The right posterior septal pathway was a bystander because it had a higher refractory period than the atrioventricular node.
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https://crimsonpublishers.com/smoaj/fulltext/SMOAJ.000504.php
For more Open access journals in Crimson Publishers
Please click on: https://crimsonpublishers.com/
For more articles in Open access journal of Innovation in Surgical Medicine Open Access Journal Please click on: https://crimsonpublishers.com/smoaj/index.php
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EP10: An Unusual Case of Lung Collapse in a patient with Arteriovenous Fistula
1. AN UNUSUAL CASE OF LUNG COLLAPSE IN A PATIENT WITH ARTERIOVENOUS FISTULA
Jasuja S1, Sagar G1, Mahajan R 2, Gupta AK1
1Department of Nephrology, 2 Department of Vascular Surgery Indraprastha Apollo Hospitals, New Delhi, India.
Background: Arteriovenous fistula (AVF) for hemodialysis
can become hyperdynamic and have local or systemic
complications. We present a very unusual complication of
such an AVF.
Case Report: A 40-year-old male with End Stage Renal
Disease on maintenance hemodialysis for three years
presented with epistaxis, hemoptysis, accelerated
hypertension (HTN) and breathlessness.
Examination showed a well functioning radio-cephalic
arteriovenous fistula with swelling and palpable thrill in the
entire right arm. There were distended veins over chest
wall (Fig1& 2). He was managed with anterior nasal packing
and anti-hypertensive treatment. His condition deteriorated
and oxygen saturation dropped. Chest radiograph (CXR)
showed complete collapse of right lung (Fig 3). He was
intubated and ventilated. Bronchoscopy revealed bilateral
clots; right main bronchus was occluded. (Fig 4) Contrast
enhanced CT scan revealed an enhancing mass lesion
partially occluding the right main bronchus (Fig 5&6).
Angiogram was suggestive of a highly vascular lesion in
the right main bronchus fed by bronchial artery, with
bronchial artery to pulmonary vein fistula (Fig 7).
Vascular Doppler showed hugely increased flows in the AVF
& enormously dilated veins. There was no thrombosis or
stenosis. A possible link between hyper-dynamic AVF and
pulmonary arterio-venous fistulous communication was
considered.
The AVF was surgically ligated with resultant dramatic
decrease in swelling of the right arm. (Fig8) Repeat
bronchoscopy two days later showed no vascular tumor or
fresh bleed. Clot clearance and full expansion of the right
lung was achieved. CT pulmonary angiogram five days after
AVF ligature also showed fully expanded lung with no
evidence of any vascular communication (Fig9).
Conclusion: It appears that in addition to the aspiration of
epistaxis, the right lung collapsed due to a vascular pseudo-
tumor, the result of a bronchial artery to pulmonary vein fistulous
communication, latent fistulas, which are known to open in hyper
dynamic circulatory flows.
Fig 1
References:
•Bachelda P, Kojecky Z, Utikal P, Drac P, Herman J, Zadrazil J. Peripheral venous
hypertension after the creation of arteriovenous fistula for hemodialysis.
Biomed.Papers 2004, 148(1), 85-87
•Smith SR, Little M, Schwab SJ, Post TW. Nonthrombotic complications of chronic
hemodialysis arteriovenous vascular access. Uptodate.com version16.3, 2008
•Salim S, Ganeshram P, Patel AD et al. Unilateral hemothorax in a 46 year old south
Indian male due to giant arterio venous fistula: a case report. Cases journal.com
2008, 1:225
•Diskin CJ, Stokes TJ, Dansby LM, Radcliff L, Carter TB, and Lazenby A. A
dialysis patient with blurred vision. NDT Plus2008; 4: 250-252.
•Nakhoul F, Yigla M, Gilman R, Reisner SA, Abassi Z, The pathogenesis pulmonary
hypertension in hemodialysis patients via arteriovenous access. Nephrol Dial
Transplant 2005; 20; 1686-1692.
Fig 2
Fig 3 Fig 4
Fig 5 Fig 6
Fig 7 Fig 8
Fig 9
