Diffuse Alveolar Hemorrhage

The diffuse alveolar hemorrhage is a persistent or recurrent pulmonary hemorrhage. There are numerous causes, but autoimmune diseases are most common. Most patients show dyspnea, cough, hemoptysis and new alveolar infiltrates on chest image. Diagnostic tests are based on the suspected cause. Treatment is with immunosuppressive drugs in patients with autoimmune causes and respiratory support if necessary.

The diffuse alveolar hemorrhage is not a specific disease but a syndrome suggesting a differential diagnosis and a specific sequence of tests.

The diffuse alveolar hemorrhage is a persistent or recurrent pulmonary hemorrhage. There are numerous causes, but autoimmune diseases are most common. Most patients show dyspnea, cough, hemoptysis and new alveolar infiltrates on chest image. Diagnostic tests are based on the suspected cause. Treatment is with immunosuppressive drugs in patients with autoimmune causes and respiratory support if necessary. The diffuse alveolar hemorrhage is not a specific disease but a syndrome suggesting a differential diagnosis and a specific sequence of tests. Pathophysiology diffuse alveolar hemorrhage is due to widespread damage to the small pulmonary vessels, leading to accumulation of blood in the alveoli. If enough alveoli are affected, the gas exchange is disturbed. The specific pathophysiology and appearance varies depending on the cause. The isolated pauci-immune pulmonary Capillaritis example, limited to the pulmonary vasculitis of small vessels, which manifests itself exclusively as alveolar hemorrhage in patients between 18-35 years. Idiopathic pulmonary hemosiderosis Idiopathic pulmonary hemosiderosis (IPH) is a rare disease that recurrent diffuse alveolar hemorrhage without demonstrable underlying disease causes; it occurs <10 years, especially in children. It is believed that it is caused a defect in the alveolar capillary endothelium, possibly due to autoimmune injury. Many affected patients have celiac disease. Symptoms and signs of IPH in children include recurrent episodes of shortness of breath and coughing, especially initially nonproductive cough. Hemoptysis occurs later. Children with idiopathic pulmonary hemosiderosis can show an iron deficiency anemia developmental disabilities. The most common symptoms in adults are exertional dyspnea and fatigue due to pulmonary hemorrhage and iron deficiency anemia. The diagnosis derIPH involves the detection of a combination of characteristic clinical findings, iron deficiency anemia and hemosiderin-laden macrophages in the BAL or lung biopsy samples plus no evidence of vasculitis of small vessels (pulmonary Capillaritis) or other causative diagnoses. It is confirmed by a lung biopsy if other findings are inconclusive. Corticosteroids can reduce the alveolar hemorrhage and control the progression of pulmonary fibrosis morbidity and mortality from acute episodes. Some patients need additional immunosuppressive drug treatment. Patients with celiac disease and IPH will also be put on a strict gluten-free diet. Etiology Many diseases can lead to alveolar hemorrhage; they include autoimmune diseases (eg. as systemic vasculitis, Goodpasture's syndrome, antiphospholipid antibody syndrome, connective tissue disease) Pulmonary infections (eg. as hantavirus infection) Toxic exposure (z. B. trimellitic anhydride, isocyanates, crack cocaine, certain pesticides ) drug reactions (for. example, propylthiouracil, diphenylhydantoin, amiodarone, methotrexate, nitrofurantoin, bleomycin, montelukast, infliximab) heart disease (eg. B. mitral stenosis) coagulation disorders caused by diseases or anticoagulant Isolated pauci-immune pulmonary capillaritis idiopathic pulmonary hemosiderosis bone marrow or organ transplantation symptoms and complaints symptoms and Besch be a slight diffuse alveolar hemorrhage include dyspnea, cough and fever. Many patients present with acute respiratory failure, which ends sometimes fatal. Hemoptysis are common, but may be missing one-third of patients in up. Most patients have anemia and a continuous bleeding with decreasing hematocrit. There are no specific physical examination findings. Other manifestations are dependent on the underlying disease (eg. As in patients with diastolic mitral stenosis). Diagnostic chest X-ray lavage serological and other tests to diagnose the cause, the diagnosis is suspected by dyspnea, cough and hemoptysis, which occur together with the Fund diffuse bilateral alveolar infiltrates on chest x-ray if a diffuse alveolar hemorrhage is suspected. A bronchoscopy with bronchoalveolar lavage is strongly recommended to confirm the diagnosis, especially if the manifestations are atypical or airway source of the hemorrhage was not excluded. Blood samples have numerous erythrocytes and siderophages. The lavage fluid typically remains hemorrhagic or is increasingly hemorrhagic after sequential scanning. Cause review further cause tests should be performed. For the avoidance of glomerulonephritis urine tests are indicated. Serum BUN and creatinine should be measured. Other routine tests include blood platelet count Coagulationsstudien Serological tests (antinuclear antibodies, anti-dsDNA, anti-GBM AK [anti-glomerular basement membrane AK], ANCA [anti-neutrophil cytoplasmic antibody], antiphospholipid AK). Serological tests are done to look for underlying disorders. Perinuclear-ANCA (P-ANCA) - counts are increased in some cases of isolated pauci-immune pulmonary Capillaritis. Alveolar hemorrhage with permission of the publisher. For Cohen A., R. Glassock In Atlas of Diseases of the Kidney: glomerulonephritis and vasculitis. Edited by R. Schrier (Series Editor), R.J. Glassock and A. H. Cohen. Philadelphia, Current Medicine, 1999. var model = {thumbnailUrl: '/-/media/manual/professional/images/alveolar_hemorrhage_high_de.jpg?la=de&thn=0&mw=350' imageUrl: '/ - / media / manual / professional / images / alveolar_hemorrhage_high_de.jpg lang = en & thn = 0 ', title:'? Alveolar hemorrhage 'description:' u003Ca id = "v37893132 " class = ""anchor "" u003e u003c / a u003e u003cdiv class = ""para "" u003e u003cp u003eBeidseitige alveolar opacities in a patient with alveolar hemorrhage u003c / p u003e u003c / div u003e 'credits'. with permission of the publisher. For Cohen A.

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