Category Archives: Hemoptysis

Hemoptysis in a 49-Year-Old Man (8)

Conclusion Our patient is interesting for many reasons. Even though the LAC-USC Medical Center has many cases of amebiasis, in this patient the diagnosis was delayed for over two weeks. The patient was initially treated for a community-acquired bacterial pneumonia and tuberculosis. When he did not respond to adequate antibiotic therapy, bronchoscopy was performed to exclude lung cancer. The lack of abdominal findings and the history of hemoptysis and cigarette use contributed to the misdiagnosis. Hemoptysis is not uncommon in pleuropulmonary amebiasis,’ and in fact, massive hemoptysis has been reported. This sign also is associated with pulmonary tuberculosis particularly in many patients from areas where tuberculosis is endemic. Elevated alkaline phosphatase levels, a nonspecific marker for amebic liver abscess, are also present in tuberculosis involving the liver. (more…)

Hemoptysis in a 49-Year-Old Man (7)

Hemoptysis in a 49-Year-Old Man (7)One of the manifestations of diaphragmatic rupture is amebic empyema, with incidence rates of 9 to 62 percent. Rarely are cysts identified in the pleural fluid, sputum or stool.’ The empyemas often respond well to conservative treatment which would include a chest tube, but in some series 20 to 40 percent of the patients required invasive procedures such as rib resection and decortication. All pleural effusions should be evaluated by a thoracentesis to differentiate a reactive pleural effusion, which would require only chemotherapy, from an empyema. Lung abscesses occur in about one third of all the patients* with pleuropulmonary amebiasis, whereas as many as half of the patients may have hepatobronchial fistulas.- A patient with hepatobronchial fistulas may empty the liver abscess by expectorating a large amount of dark-colored sputum. (more…)

Hemoptysis in a 49-Year-Old Man (6)

Serologic findings significantly contribute to the diagnosis of pleuropulmonary amebiasis. Indirect hemagglutination, because of its better sensitivity and easier performance, is the recommended test. Complement fixation and gel diffusion also are sensitive tests. Although, all these tests are nearly always positive in patients with an amebic liver abscess, they are also positive in 60 percent of asymptomatic subjects who pass cysts. Thus, a positive amebic serology test alone would not prove liver involvement. The differential diagnosis of pleuropulmonary amebiasis includes tuberculosis, empyema, cancer and pyogenic lung abscess. Chronic cough, hemoptysis and fever can occur in all of these conditions. The diagnostic process further is confounded by the similar geographic distribution of amebiasis and tuberculosis. The patients with pleuropulmonary amebiasis often are younger than lung cancer patients. (more…)

Hemoptysis in a 49-Year-Old Man (5)

An enlarged, tender liver and respiratory symptoms in a patient from an area where E histolytica is endemic would be highly suggestive of pleuropulmonary amebiasis. Unfortunately, the abdominal examination often is unhelpful in such patients. Laboratory abnormalities are nonspecific and include leukocytosis, anemia, an elevated sedimentation rate and abnormal alkaline phosphatase and transaminase values. However, all or many of these tests may be normal in pulmonary amebiasis. Chest roentgenograms commonly show an elevated and poorly mobile right diaphragm, right lower lobe consolidation, infiltrates or pleural effusion. Cardio-megaly, if present, may indicate pericardial effusion. The Mexican hat sign, an exotic radiographic anomaly, may be present, but is not pathognomonic. Lung abscesses usually involve the right lower lobe, but occasionally one or both lungs may be affected. (more…)

Hemoptysis in a 49-Year-Old Man (4)

Hemoptysis in a 49-Year-Old Man (4)Discussion Amebiasis, caused by Entamoeba histolytica, is endemic in many areas of the world including south and southeastern Asia, South Africa, Mexico and even some areas of the United States. Occasionally amebiasis is diagnosed in patients in nonendemic areas because of their recent travels. The cyst form, mainly transmitted by contaminated water and food, develops into the trophozoite stage in the intestine. The host may remain asymptomatic but may pass cysts or the disease may invade the bowel causing a dysentery syndrome. Spread of the disease to the liver leads to abscess formation. Although the liver is primarily involved, the lung is the second most commonly involved organ; the brain and spleen are rarely involved. (more…)

Hemoptysis in a 49-Year-Old Man (3)

The fluid was an exudate with 670 VVBCs (60 percent PMNs and 33 percent lymphocytes). A pleural biopsy was then performed which showed mild chronic inflammation. Acid-fast organisms or granulomas were not observed. A bronchoscopy performed six days after admission showed compression and distortion of the bronchus intermedins with bl<x>d and copious thick cottage cheese-like material coming from the right middle and lower lobes. Because the patient developed hypoxemia, bronchial biopsy specimens were not obtained. Bronchial lavage and brushing specimens showed no malignant cells, acid-fast bacilli or fungi. (more…)

Hemoptysis in a 49-Year-Old Man (2)

Blood tests that yielded abnormal results included the following: alkaline phosphatase level, 259 units/L (normal:<110 units/L); a calcium value, 8.0 mg % (normal:8.5-10.5 mg/100 ml); total protein level, 6.2 g % (normaI:6.5-9 g/100 ml); albumin value, 2.5 g % (normal:3.5-5.0). The white blood cell count was mildly elevated (13.9/cu mm/g/100 ml), with a differential cell count of 63 percent segmented neutrophils, 15 percent band cells, 15 percent lymphocytes and 7 percent monocytes. The hematocrit value was 24.7 percent with a MCV of 85.7. A posteroanterior view of the chest showed right pleural effusion, right apical infiltrates and loss of volume of the right upper lobe (Fig 1). (more…)

Hemoptysis in a 49-Year-Old Man (1)

Hemoptysis in a 49-Year-Old Man (1)Herein we report the case of a patient who had pleuropulmonary amebiasis. The 49-year-old man whose case is presented complained of hemoptysis without gastrointestinal symptoms. Case Report A 49-year-old man came to LAC-USC Medical Center with a six-week history of blood-streaked sputum. During the preceding three weeks he had lost 22 pounds in weight. He complained of general fatigue, occasional occurrences of fever, chills and night sweats. He had no cough, shortness of breath, abdominal pain or cramping. Three weeks before presentation he experienced diarrhea, which lasted for five days and subsided without any treatment. On this visit to the hospital he had a dull ache in the right lower posterior thorax. (more…)