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Haemoptysis as a presenting feature of hepatopulmonary disease

Published:February 04, 2019DOI:https://doi.org/10.1016/j.ejim.2019.01.020
      The report of haemoptysis as a presenting feature of hepatic-pulmonary disease [
      • Catano J.C.
      • Agredo D.K.
      Hepatic-pulmonary disease.
      ] is testimony to the importance of hepatic-pulmonary disease in the differential diagnosis of haemoptysis. This differential diagnosis includes amoebic liver abscess, which presented with recurrent bouts of haemoptysis of such severity as to require 2 units blood transfusion. Subsequently, however, in contrast to the patient's description of the sputum, some clinicians found it to be thick reddish in colour, with plenty of degenerate cells mixed with red blood cells. On examination, the patient, a 32 year old man, documented as being a “smoker and alcoholic”, had soft tender hepatomegaly with a span of 18 cm. Chest x-ray revealed a homogenous opacity involving the right lower lung field. Subsequent investigation revealed evidence of a hepato-bronchial fistula [
      • Talukdar A.
      • Mukherjee K.
      • Khanna D.
      • Saha M.
      An unusual cause of haemoptysis: a diagnostic challenge.
      ]. The association of cirrhosis-related portal hypertension and bronchial varices is another important cause of haemoptysis attributable to hepatopulmonary disease [
      • O'Brien J.
      • Cowan M.
      • Patch D.
      Haematemesis, haemoptysis, or both?.
      ].

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      References

        • Catano J.C.
        • Agredo D.K.
        Hepatic-pulmonary disease.
        Eur. J. Intern. Med. 2012; https://doi.org/10.1016/l.ejm2018.12.013
        • Talukdar A.
        • Mukherjee K.
        • Khanna D.
        • Saha M.
        An unusual cause of haemoptysis: a diagnostic challenge.
        BMJ Case Rep. 2012; https://doi.org/10.1136/bcr-2012-006751
        • O'Brien J.
        • Cowan M.
        • Patch D.
        Haematemesis, haemoptysis, or both?.
        Lancet. 2013; 381: 346