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CHEST IMAGE
Year : 2014  |  Volume : 2  |  Issue : 2  |  Page : 96

A radiological clue of etiology of massive hemoptysis


1 Department of Pulmonary Medicine, Medical College, Kolkata, West Bengal, India
2 Department of Pulmonary Medicine, North Bengal Medical College, Darjeeling, West Bengal, India

Date of Web Publication23-Jun-2014

Correspondence Address:
Sibes K Das
Souhardya Apartment, West Bankimpally, Madhyamgram, Kolkata 700 129, West Bangal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2320-8775.135131

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How to cite this article:
Das A, Das SK, Basuthakur S, Bairagya TD. A radiological clue of etiology of massive hemoptysis. J Assoc Chest Physicians 2014;2:96

How to cite this URL:
Das A, Das SK, Basuthakur S, Bairagya TD. A radiological clue of etiology of massive hemoptysis. J Assoc Chest Physicians [serial online] 2014 [cited 2021 Jul 30];2:96. Available from: https://www.jacpjournal.org/text.asp?2014/2/2/96/135131

A 45-year-old male patient presented with massive hemoptysis for 4 days. He was treated for pulmonary tuberculosis 20 years back. Contrast-enhanced computed tomography scan thorax showed right upper zone cavitary lesions with rounded density within two cavities [Figure 1]. Computed tomography (CT) angiography revealed feeding bronchial vessels of mycetomas [Figure 2]. Sputum for acid fast bacilli was negative. He was diagnosed as multiple mycetomas within healed tuberculous cavities.
Figure 1: Contrast-enhanced computed tomography thorax showing two mycetomas in posttuberculous cavities of right upper lobe and change of position the mycetoma with change of body position

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Figure 2: Computed tomography angiogram showing feeding bronchial vessels (arrows) of mycetomas

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Saprophytic colonization of fungal hyphae within a pulmonary cavity or ectatic bronchi is called mycetoma. [1] It consists of dead and living mycelial elements, along with mucus and cellular debris. Most mycetomas are caused by Aspergillus fumigatus. It complicates pulmonary cavities following tuberculosis, sarcoidosis, histoplasmosis, blastomycosis, asbestosis, etc.

Computed tomography scan thorax shows a solid rounded mass of soft tissue density within a cavity separated from the cavity wall by an air space-the Crescent sign or Monod sign. The fungal ball moves with the change of position of the patient. Mycetoma is often solitary, but may be bilateral or multiple, [2] as our case. CT angiography often identifies the hypertrophic bronchial vessels supplying the cyst wall, which are the source of massive hemoptysis in most cases.

Bronchial artery embolization is often the procedure used as "bridge procedure" in patients with massive hemoptysis until surgical resection of the aspergiloma is performed. [3]

 
  References Top

1.Fraser RS, Colman N, Müller NL, Paré PD. Infectious diseases of the lungs. In: Fraser RS, Colman N, Müller NL, Paré PD, editors. Synopsis of Diseases of the Chest. 3rd ed. Philadelphia: Saunders; 2005. p. 222-336.  Back to cited text no. 1
    
2.Adeyemo AO, Odelowo EO, Makanjuola DI. Management of pulmonary aspergilloma in the presence of active tuberculosis. Thorax 1984;39:862-7.  Back to cited text no. 2
    
3.Uflacker R, Kaemmerer A, Picon PD, Rizzon CF, Neves CM, Oliveira ES, et al. Bronchial artery embolization in the management of hemoptysis: Technical aspects and long-term results. Radiology 1985;157:637-44.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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