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Hu Q, Guo Y, Fan H, Wu X, Chen H, Zeng C. Pathological features of vascular wall in Dieulafoy's disease. Pathol Res Pract 2023; 249:154782. [PMID: 37639956 DOI: 10.1016/j.prp.2023.154782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/25/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
AIMS Although there are many clinical reports on Dieulafoy's disease, there are few studies on the pathological structure of vascular wall in Dieulafoy's disease. METHODS In this study, the main structural changes of the intima and media of the vascular wall were observed by special staining and immunohistochemical methods in the subjects of Dieulafoy's disease of stomach and intestine. RESULTS There were many vessels of different sizes in the submucosa, with uneven wall thickness of the vessels. Compared with the normal control group, the content of blue collagen fibers between the vascular smooth muscle cells in the lesion group was increased, the elastic fibers were thickened, and the internal elastic plate was arranged stiff or even interrupted. CONCLUSIONS The increase of collagen and elastic fibers between the smooth muscle cells of the medium membrane and the destruction of the structure of the inner elastic plate may be the structural basis of vascular lesions leading to Dieulafoy's disease.
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Affiliation(s)
- Qiaoling Hu
- Department of Pathology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518033, PR China
| | - Yimin Guo
- Department of Pathology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518033, PR China
| | - Huan Fan
- Department of Pathology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518033, PR China
| | - Xiaobin Wu
- Department of Gastrointestinal Surgery, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong 518033, PR China.
| | - Honglei Chen
- Gastrointestinal Endoscopy Center, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518033, PR China.
| | - Chao Zeng
- Department of Pathology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518033, PR China.
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Abstract
Dieulafoy's disease is characterized by abnormal submucosal arteries and results in acute luminal hemorrhage. Dieulafoy's lesions can also be found in the submucosa of the bronchus. Due to its low incidence rate and non-specific clinical symptoms, Dieulafoy's disease is easy to overlook, but can lead to massive bleeding and high rates of mortality. Therefore, improvements in the understanding of the disease are necessary. The awareness of the disease and associated diagnostic and treatment techniques have continued to improve, and thus, an increasing number of cases of Dieulafoy's disease of the bronchus have been reported. In the present review, 74 cases of Dieulafoy's disease are summarized. New technologies such as endobronchial ultrasound, narrow-band imaging, angiography and argon plasma treatment have been found to be increasingly applied to diagnose and treat Dieulafoy's disease of the bronchus. Therefore, the primary focus of this systematic review is to highlight advances in the diagnosis and treatment of bronchial Dieulafoy's disease.
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Affiliation(s)
- Xiqian Xing
- Department of Respiratory Medicine, The Affiliated Hospital of Yunnan University, The Second People's Hospital of Yunnan Province, Kunming, Yunnan 650021, P.R. China
| | - Jie Liu
- Department of Respiratory Medicine, The Affiliated Hospital of Yunnan University, The Second People's Hospital of Yunnan Province, Kunming, Yunnan 650021, P.R. China
| | - Shuanglan Xu
- Department of Respiratory Medicine, The Affiliated Hospital of Yunnan University, The Second People's Hospital of Yunnan Province, Kunming, Yunnan 650021, P.R. China
| | - Yishu Deng
- Department of Respiratory Medicine, The Affiliated Hospital of Yunnan University, The Second People's Hospital of Yunnan Province, Kunming, Yunnan 650021, P.R. China
| | - Jiao Yang
- First Department of Respiratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
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Giordano M, Bigazzi MC, Palladino MT, Russo MG. A rare cause of massive hemoptysis in a child: Bronchial Dieulafoy's disease - the first report of transcatheter treatment in pediatric age. Ann Thorac Med 2020; 15:244-246. [PMID: 33381240 PMCID: PMC7720747 DOI: 10.4103/atm.atm_163_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/12/2020] [Indexed: 12/31/2022] Open
Abstract
We report a case of bronchial Dieulafoy's disease in the pediatric age. Angio-computed tomography scan and arteriography addressed us to diagnosis. Bronchial endoscopy with biopsy was avoided due to the high risk of developing a life-threatening hemorrhage. Transcatheter embolization of the bleeding bronchial artery was achieved with a MicroPlex® 10 HyperSoft 3D 3.5 mm × 80 mm System (MicroVention, Tustin, CA, USA). Dieulafoy's disease is an extremely rare lesion in the pediatric age, and the small diameter of the bleeding vessels may complicate the percutaneous approach with procedural failure. Currently, the novel thin and soft detachable coils allowed to widen the transcatheter embolization in the pediatric age.
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Affiliation(s)
- Mario Giordano
- Department of Paediatric Cardiology, “Ospedali dei Colli,” University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Maurizio Cappelli Bigazzi
- Department of Paediatric Cardiology, “Ospedali dei Colli,” University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Maria Teresa Palladino
- Department of Paediatric Cardiology, “Ospedali dei Colli,” University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Maria Giovanna Russo
- Department of Paediatric Cardiology, “Ospedali dei Colli,” University of Campania “Luigi Vanvitelli,” Naples, Italy
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Chen W, Chen P, Li X, Gao X, Li J. Clinical characteristics and treatments for bronchial Dieulafoy's disease. Respir Med Case Rep 2019; 26:229-235. [PMID: 30740302 PMCID: PMC6357209 DOI: 10.1016/j.rmcr.2019.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 01/04/2019] [Accepted: 01/04/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Dieulafoy's disease of the bronchus is an arterial abnormality characterized by enlarged mucosal arterial branches that are susceptible to lethal bleeding. To date, this disease is rarely reported in the literature. We recently encountered three patients from February 2010 to March 2017, each with such a vascular anomaly in a bronchus with massive hemoptysis. AIM This paper describes the clinical characteristics and treatments for Dieulafoy's disease. METHODS We report three cases with recurrent massive hemoptysis. Bronchoscopic examination was performed on two patients, one with a non-pulsating polypoid nodule and the other without. One patient had fatal bleeding after biopsy and could not withstand bronchial artery embolization or thoracotomy. Angiography and bronchial artery embolization on another two patients successfully stopped the bleeding. In addition, we retrospectively reviewed the literature on all reported cases with cryptogenic hemoptysis, obtained through PubMed and Chinese journal searches. RESULTS The intervention with embolization was successful, and no new episodes of acute hemoptysis were observed. CONCLUSION Angiography can be used for diagnosis of Dieulafoy's disease of the bronchus, whereas bronchoscopy biopsy should be avoided. Interventions such as embolization or bronchial coagulation play an important role in patients with coughing with massive hemoptysis.
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Affiliation(s)
- Wenfang Chen
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangdong Geriatrics Institute, Shantou University Medical College, Guangdong, 510080, China
| | - Pingping Chen
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangdong Geriatrics Institute, Guangdong, 510080, China
| | - Xiuyu Li
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangdong Geriatrics Institute, Guangdong, 510080, China
| | - Xinglin Gao
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangdong Geriatrics Institute, Guangdong, 510080, China
| | - Jing Li
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangdong Geriatrics Institute, Guangdong, 510080, China
- Corresponding author.
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Madan K, Dhungana A, Hadda V, Mohan A, Guleria R. Flexible bronchoscopic argon plasma coagulation for management of massive hemoptysis in bronchial Dieulafoy's disease. Lung India 2017; 34:99-101. [PMID: 28144074 PMCID: PMC5234213 DOI: 10.4103/0970-2113.197096] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Dieulafoy's disease is an uncommon condition, the usual site of occurrence being the gastrointestinal tract. The condition refers to the presence of a dysplastic submucosal artery with mucosal vascular branches that has propensity to cause recurrent bleeding. Dieulafoy's disease of the bronchus is rare. Herein, we describe the case of a 26-year-old male who presented with recurrent bouts of hemoptysis and bronchial Dieulafoy's disease was diagnosed. Flexible bronchoscopy was performed, and argon plasma coagulation (APC) of the bleeding lesion was done. The procedure was successful and was followed by complete eradication of the vascular malformation and cessation of hemoptysis. APC is a useful tool in the armamentarium of an interventional pulmonologist that can allow rapid and safe control of bleeding from superficially located and bleeding endobronchial lesions, and can be easily and effectively applied using a flexible bronchoscope.
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Affiliation(s)
- Karan Madan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Ashesh Dhungana
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
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Huang Y, Liang J. Progress in treatment of bleeding in Dieulafoy's disease by endoscopic metal titanium clamp. Shijie Huaren Xiaohua Zazhi 2016; 24:2492-2497. [DOI: 10.11569/wcjd.v24.i16.2492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Dieulafoy's disease is one of the rare causes of upper gastrointestinal bleeding. Since its pathogenesis is different from that of common gastrointestinal bleeding, traditional acid suppression method has a poor therapeutic effect. Over the past decade, endoscopic hemostatic technologies have developed rapidly and have been vigorously recommended as the preferred method to replace surgery. Among them, endoscopic metal clamp stops bleeding quickly, has a definite curative effect distinctly, and is increasingly advocated by clinicians. However, large-sample studies on endoscopic metal titanium clamp in the treatment of bleeding in Dieulafoy disease are still lacking. This paper systematically reviews the recent advances in the treatment of bleeding in Dieulafoy's disease by endoscopic metal titanium clamp.
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Padilla-Serrano A, Estrella-Palomares V, Martínez-Palacios B, González-Spínola J. A case of massive hemoptysis related to a smoking-history: an acquired form of the Dieulafoy's disease? Rev Port Pneumol (2006) 2015; 21:276-9. [PMID: 26227224 DOI: 10.1016/j.rppnen.2015.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/18/2015] [Accepted: 06/23/2015] [Indexed: 10/23/2022] Open
Abstract
The hypervascularization of the bronquial wall, secondary to chronic bronchopulmonary inflammation is a bleeding etiology in smokers, but insufficient to explain certain massive recurrent cases. We report a case of a woman with a smoking history who presented a recurrent and massive hemoptysis. A diagnostic study with laboratory tests, bronchoscopy, computed tomography and echocardiogram did not identify the etiological cause. However, bronchial arteriography showed right and left bronchial tortuous and dilated arteries and demonstrated that a bronchovascular fistula was the origin of the hemoptysis. An acquired form of the Dieulafoy's disease in this context of a smoking history might justify such findings. Bronchial arteriography as a diagnostic method should be the preferred choice rather than bronchoscopy in these cases.
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Affiliation(s)
- A Padilla-Serrano
- Intensive Care Unit, La Mancha Centro General Hospital, Alcázar de San Juan, Ciudad Real, Spain.
| | - V Estrella-Palomares
- Intensive Care Unit, La Mancha Centro General Hospital, Alcázar de San Juan, Ciudad Real, Spain
| | - B Martínez-Palacios
- Intensive Care Unit, La Mancha Centro General Hospital, Alcázar de San Juan, Ciudad Real, Spain
| | - J González-Spínola
- Department of Radiology, La Mancha Centro General Hospital, Alcázar de San Juan, Ciudad Real, Spain
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Ganganah O, Guo S, Chiniah M, Sah SK, Wu J. Endobronchial ultrasound and bronchial artery embolization for Dieulafoy's disease of the bronchus in a teenager: A case report. Respir Med Case Rep 2015; 16:20-3. [PMID: 26744645 PMCID: PMC4681900 DOI: 10.1016/j.rmcr.2015.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 12/16/2022] Open
Abstract
Dieulafoy's disease of the bronchus is a relatively rare cause of hemoptysis. It can be completely asymptomatic and diagnosed as an incidental finding on bronchoscopy. At the other end of the spectrum, it can present with potentially fatal hemorrhage. We present a case of a 13-year old boy who suffered from massive hemoptysis. Endobronchial ultrasound (EBUS) and bronchial artery embolization (BAE) proved useful in the initial management. This case may support the role of EBUS in the diagnosis of Dieulafoy's disease as well as other intrapulmonary vascular lesions.
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Smith B, Hart D, Alam N. Dieulafoy's disease of the bronchus: a rare cause of massive hemoptysis. Respirol Case Rep 2014; 2:55-6. [PMID: 25473566 PMCID: PMC4184505 DOI: 10.1002/rcr2.47] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 11/12/2013] [Indexed: 01/08/2023] Open
Abstract
We present the case of a 30-year-old non-smoker who presented with unexplained, massive hemoptysis and was diagnosed with a rare vascular malformation.
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Affiliation(s)
- Ben Smith
- St Vincent's Hospital Melbourne, Australia
| | - David Hart
- St Vincent's Hospital Melbourne, Australia
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