Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Exercise-induced pulmonary hemorrhage
- Radiologic Findings
- Among 8 years, patient was visited hospital several times complaining of recurrent blood-tinged sputum, hemoptysis and dyspnea after strenuous exercise. In fact, the patient was amateur marathoner who runs about 100 km a week. First CT scan demonstrated patchy consolidation and GGO in the LLL posterior basal segment. Bronchoscopy showed focal bleeding at the LB 10 (posterior basal segmental bronchus) at that time. Five years later, the patient underwent additional CT scan for evaluating his hemoptysis, CT demonstrated new, ill-defined geographic GGO in BULs. These lesions were disappeared on the last CT image which was took three years later, and another geographic GGO newly demonstrated in BUL, especially RUL. Considering the image findings and clinical aspects together, it was possible to assume that the patient's symptoms and images were caused by severe exercise.
- Brief Review
- Exercise-induced pulmonary hemorrhage (EIPH) or exercise-induced pulmonary edema (EIPE) have frequently been documented in racehorses, however, EIPH/EIPE have also been often described with hard aerobic exercise in humans including marathon runners, triathletes, cyclists, and swimmers. EIPH may presented with a variety of clinical symptoms, including asymptomatic patients, cough, dyspnea, blood-tinged sputum, hemoptysis, or epistaxis after extreme exercise.
Capillary wall tearing was one of the pathogenesis explaining the disease. Exercise elevates pulmonary capillary pressures and can affect the integrity of the blood-gas barrier. With extreme exertion, these changes result in increased permeability and cause bleeding into the lung.
Recent histological studies identified extensive remodeling of small pulmonary veins in EIPH/EIPE-affected horse lungs. Strenuous exercise results in high pulmonary vascular pressure and high vascular pressure results in pulmonary vein wall remodeling. Those lesions lead to diminished vein lumen diameter and during hard exercise, venous occlusion induces regionally increased pulmonary capillary pressure, capillary rupture and bleeding.
Imaging findings are non-specific and may appear in the form of pulmonary hemorrhage or pulmonary edema. The bronchoscopic evaluation, including the bronchoalveolar lavage can help with diagnosis.
- References
- 1. Andrew J. Ghio, Christine G., Maryann B. Exercise-induced pulmonary hemorrhage after running a marathon, Lung, 2006;184:331–333
2. DS Kim, MH Lee, et al., A 45-Year-Old Man With Recurrent Dyspnea and Hemoptysis during Exercise: Exercise-Induced Pulmonary Hemorrhage/Edema, Tuberc Respir Dis 2015;78:375–379
- Keywords
- lung, Pulmonary hemorrhage,