Diffuse Alveolar Hemorrhage: Initial and Follow-up HRCT Features Poster No.: E-0037 Congress: ESTI 2012 Type: Authors: Keywords: Scientific Exhibit M. Y. Kim; Seoul/KR Lung, CT-High Resolution, CT, Computer Applications-Detection, diagnosis, Hemorrhage, Infection, Connective tissue disorders Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 9
Objectives Diffuse alveolar hemorrhage (DAH) is a clinicopathologic syndrome that results from a variety of conditions and should be considered a life-threatening event. DAH is recognized by the clinical constellation of hemoptysis, anemia, diffuse radiographic pulmonary infiltrates, and hypoxemic respiratory failure. This exhibition demonstrates initial and follow-up HRCT findings of DAH according to etiology. Materials and Methods We reviewed 23 episodes of DAH in 20 patients, 19 of known etiology (7-Leptospirosis, 5-Vasculitis, 2-Invasive aspergillosis, 2-Hemorrhagic metastasis, 2-Mitral valve disease, and 1-hemophilia) and one of unknown etiology. A complete initial and follow-up HRCT were available for all patients. Parenchymal consolidations and ground-glass opacities were evaluated. Results Diffuse consolidations or ground-glass opacities were identified on initial HRCT in 20/20 patients. Air space lesion showed almost complete resolution on follow-up HRCT. Diffuse alveolar hemorrhage component on initial HRCT was reversible finding on followup HRCT after proper treatment of underlying disease. Images for this section: Page 2 of 9
Fig. 1: A. 81-Year-old mas with Leptospirosis. A. Initial coronal-reformatted CT image shows diffuse GGO (ground glass opacity) in both lungs with random distribution. B. Note resolved diffuse GGO on follow-up CT. Fig. 4: A 38-year-old woman with mitral regurgitation and pumonary hypertension. A. B. Initial Transverse-CT images shows pathcy consolidation and surrounding GGO in left lung. C. Gross specimen shows hemorrhage. On follow CT, above findings was disappread (not shown). Page 3 of 9
Fig. 5: A 39 year-old-man with migral regurgitation. A. B. Initial axial-ct images show diffuse ill-defined GGO nodules in both lungs, that means petechial hemorrhage. C. D. Long-term follow-up CT images show well defined diffuse nodules in both lungs, that means subsequent pulmonary hemosiderosis. Page 4 of 9
Fig. 9: A 75-year-old woman with idiopathic diffuse alveolar hehmorrhage. A. B. Initial axial CT images show diffuse dependent consolidation and non dependent GGO with random distribution in both lungs. C. D. Follow-up CT images show interal resolved. Page 5 of 9
Fig. 2: A 63-year-old woman with invasive pulmonary aspergillosis. A. Initial coronalreformatted CT shows extensive airspace consolidaation in both lungs with mild sparing in the right lower lobe. B. First follow-up CT shows decreased previous extensive airspace consolidaation in both lungs. New ill-defined cavitary consolidations is shown in the both upper lobes, suggestive finding of invasive pulmonary aspergillosis. C. Second follow-up CT image shows decreased previous cavitary consolidaation in both upper lobes. There is focal fibrotic consolidation in the left upper lobes, suggestive finding of healed invasive pulmonary aspergillosis. Page 6 of 9
Fig. 8: A 22-year-old woman with Systemic lupus erythematosus with DAH. A. B. Initial coronal-reformateed images show ill-defined GGO foci in both lungs and a few nodular consolidation in right lung. Disappeared airspace lesion on follow-up CT (not shown). Fig. 6: A 58-year-old man with ANCA positive granulomatous vasculitis (Wegener's granulomatosis) with hemorrahge. A. Initial axial CT image shows ill defined GGO foci in both lungs. B. On follow-up CT, ill defined GGO foci are decreased in extent. Page 7 of 9
Fig. 7: A 49-year-old woman with systemic lupus erythematosus with diffuse pulmonary hemorrhage. A. B. Initial coronal-reformated CT images show both parahilar consolidation and fuzzy GGO. Consolidation and GGO were disappeared on follow-ct, rapidly (not shown). Fig. 3: A 73-year-old man with lung metastasis from angiosarcoma of the scalp. A. Initial coronal-reformatted image shows two cavities with surrounding GGO in the both upper lobes, so called 'CT halo sign'. On follow-up CT, cavities are increased and surrounding GGOs are decresed. GGO is hemorrhagic component. Page 8 of 9
Conclusions DAH is radiologically characterised by a nonspecific alveolar-filling pattern. HRCT finding of DAH was almost reversible on follow-up. Diagnosis or suspicion of DAH needs to be supported by the evidence of haemoptysis and/or rapid-onset anaemia. HRCT is superior in detecting ground-glass opacities and is required in cases of suspected DAH. A systematic approach to early recognition, especially with HRCT, establishment of diagnosis via bronchoalveolar lavage, and aggressive treatment of underlying disease likely decreases the morbidity and mortality. Page 9 of 9