In patients with a primary bronchogenic tumor, fatal hemoptysis was frequently associated with a necrotic squamous cell carcinoma. Previously, investigators have shown an increased tendency in this cell type to cause tissue necrosis and subsequent hemorrhagic infarction. A proposed mechanism for the development of necrosis in squamous cell carcinoma is tumor invasion of vascular structures leading to ischemia and avascular necrosis, a process similar to that demonstrated in patients with a hematologic malignancy and a fungal pneumonia. …Read the rest of this article
Candida spp may also play a causative role in pulmonary hemorrhage as demonstrated by two patients with hemoptysis and a Candida pneumonia. One of these patients had a C tropicalis pneumonia and developed fatal hemoptysis, whereas the patient with a C albicans pneumonia experienced only selflimited hemoptysis. The increased virulence of C tropicalis has been previously described in granulocytopenic patients, the basis for which may be elaboration of extracellular proteases. …Read the rest of this article
Unfortunately, diagnosis of fungal infections is difficult in immunocompromised patients. An antemor-tem diagnosis of fungal pneumonia was achieved in seven of eight patients in our study, but in two patients this diagnosis was made only from a sputum culture relatively late in the clinical course. Further, autopsies were not performed on all of our patients, and hence, cases of fungal pneumonia might have been undetected. Recent studies, however, have shown that bron-choalveolar lavage is superior to conventional bron-choscopic techniques in identifying fungal infections. The presence of pulmonary hemorrhage in immunocompromised patients with undiagnosed pulmonary infiltrates may also serve as a clue to the presence of a fungal infection, as 33 percent of our patients with a hematologic malignancy and hemoptysis had a fungal pneumonia. Similarly, Kahn and colleagues observed with bronchoalveolar lavage that 50 percent of patients with significant occult pulmonary hemorrhage had an Aspergillus pneumonia. …Read the rest of this article
The clinical characteristics of patients with fatal hemoptysis or nonfatal hemoptysis are presented in Table 3. The two groups contained similar proportions of patients with a bronchogenic carcinoma or a malignancy metastatic to the lung. Two patients with esophageal carcinoma and contiguous extension to the tracheobronchial tree had fatal hemoptysis. In patients with bronchogenic cancer, necrotic squamous cell carcinoma was strongly associated with fatal hemoptysis (p<0.01). Of the seven patients with necrotic squamous cell carcinoma, evidence of tissue necrosis was demonstrated on autopsy specimens (two), at bronchoscopic study (four), or by roentgenographic evidence of cavity formation (one). …Read the rest of this article
Patients were grouped by the type of neoplasm: hematologic malignancy or solid tumor. These groups were further subdivided by the severity of hemoptysis: fatal hemoptysis or nonfatal hemoptysis. Inadequate documentation of the quantity of hemoptysis in the medical records prevented further grading of the severity of hemoptysis.
Differences in frequencies of various occurrences were analyzed by a Fishers exact test A p value less than 0.05 was considered significant
Of 58 cancer patients found to have hemoptysis, 24 had a hematologic malignancy, while 34 had a solid tumor. …Read the rest of this article
Pulmonary hemorrhage occurs frequently in patients with neoplastic diseases and may become life-threatening in a significant proportion of these patients. The factors contributing to the development of fatal pulmonary hemorrhage in patients with malignant disease have not been well delineated. To address these issues, we reviewed the clinical records and available pathologic specimens from patients with a malignancy and evidence of pulmonary hemorrhage.
Material and Methods
During the period from January 1980 to June 1986, patients with a diagnosis of malignancy and hemoptysis were identified from the medical records, bronchoscopy records, or reports of the pulmonary consultation service at the University of Maryland Hospital. Complete autopsies were obtained in 26 cases and post-mortem lung biopsies were available in another two cases. …Read the rest of this article