Joop Jonckheer1, Hans Slabbynck2, Herbert Spapen1. 1. Department of Intensive Care Medicine, University Hospital Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium. 2. Department of Pulmonology, Middelheim Hospital, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium.
Abstract
BACKGROUND: Diffuse alveolar haemorrhage (DAH) may accompany or complicate various diseases with different pathophysiology. The diagnosis of DAH, especially when presenting as diffuse non-resolving and predominantly upper lobe lung consolidations, is particularly difficult in patients with cardiac disease. METHODS: We retrospectively reviewed seven cases of DAH with predominant upper lobe involvement in the setting of acute or acute-on-chronic congestive heart failure (CHF). RESULTS: In general, time from onset till diagnostic confirmation of DAH was long. Chest CT scan mostly confirmed diffuse lung infiltrates without preferential side location but with typical cortical sparing in all patients. Echocardiography showed presence of some degree of mitral valve insufficiency in all subjects. CONCLUSIONS: Diagnosis of DAH presenting as non-resolving upper lobe densities, accompanying CHF remains cumbersome but may be suggested indirectly by the presence of cortical sparing and mitral valve insufficiency. The latter may play a crucial role in the development of DAH.
BACKGROUND: Diffuse alveolar haemorrhage (DAH) may accompany or complicate various diseases with different pathophysiology. The diagnosis of DAH, especially when presenting as diffuse non-resolving and predominantly upper lobe lung consolidations, is particularly difficult in patients with cardiac disease. METHODS: We retrospectively reviewed seven cases of DAH with predominant upper lobe involvement in the setting of acute or acute-on-chronic congestive heart failure (CHF). RESULTS: In general, time from onset till diagnostic confirmation of DAH was long. Chest CT scan mostly confirmed diffuse lung infiltrates without preferential side location but with typical cortical sparing in all patients. Echocardiography showed presence of some degree of mitral valve insufficiency in all subjects. CONCLUSIONS: Diagnosis of DAH presenting as non-resolving upper lobe densities, accompanying CHF remains cumbersome but may be suggested indirectly by the presence of cortical sparing and mitral valve insufficiency. The latter may play a crucial role in the development of DAH.
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