Tuberc Respir Dis.  2015 Oct;78(4):375-379. 10.4046/trd.2015.78.4.375.

A 45-Year-Old Man With Recurrent Dyspnea and Hemoptysis during Exercise: Exercise-Induced Pulmonary Hemorrhage/Edema

• Kim DS
• Lee M
• Kwon OJ
• Jeong I
• Son JW
• Na MJ
• Kwon SJ

• KMID: 2320710
• DOI: http://doi.org/10.4046/trd.2015.78.4.375

Abstract

A 45-year-old man presented with dyspnea and hemoptysis during exercise. A chest computed tomography (CT) revealed multifocal diffuse patchy ground glass opacity and interlobular septal thickening in both the lungs. Permeability pulmonary edema or pulmonary hemorrhage was suspected. Serologic studies for autoimmune disorders and vasculitis were negative. There was no laboratory evidence of coagulopathy, other hematopoietic disease or infectious disease. Considering correlation with exercise, we diagnosed exercise-induced pulmonary hemorrhage (EIPH) or exercise-induced pulmonary edema (EIPE). The patient was managed with antifibrinolytics, antibiotics, and antitussive agent. After a week, follow-up chest CT revealed completely resolved pulmonary hemorrhage. About 2 months after the first event, he visited again with dyspnea and hemoptysis during running. In the present study, we report a case of recurrent pulmonary hemorrhage after exercise.

Keyword

Hemoptysis; Dyspnea; Hemorrhage

MeSH Terms

Anti-Bacterial Agents
Antifibrinolytic Agents
Communicable Diseases
Dyspnea*
Follow-Up Studies
Glass
Hemoptysis*
Hemorrhage
Humans
Lung
Middle Aged*
Permeability
Pulmonary Edema
Running
Thorax
Tomography, X-Ray Computed
Vasculitis
Anti-Bacterial Agents
Antifibrinolytic Agents

Figure

• 

  Figure 1 (A) A chest radiograph obtained on the day of admission showed ground glass opacity in both the lower lung fields. (B) A chest computed tomography obtained on the day of admission demonstrates multifocal diffuse, patchy ground glass opacity and interlobular septal thickening in both the lungs and reveals permeability pulmonary edema or hemorrhage. (C) Five days after avoiding exercise, the chest radiograph shows resolving state of diffuse haziness in both the lungs. (D) Two weeks after avoiding exercise, a follow-up chest computed tomography was checked and reveals completely resolved multifocal diffuse, patchy ground glass opacity and interlobular septal thickening in both the lungs.

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  Figure 2 The first and second aliquots of broncho-alveolar lavage fluids became increasingly hemorrhagic on sequential sampling and revealed pulmonary hemorrhage.

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  Figure 3 (A, B) A chest computed tomography obtained on the second event of hemop tysis demonstrates presence of new ground glass opacity in the entire lung.

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