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Have blood in lungs, no damage and no lung history. Blood coming from mouth, taken X-ray. Suggest?

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Pulmonologist
Practicing since : 2003
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Hi My wife has just been admitted to a Thai Hospital with blood in her left lung what is this likely to be????No External Damage...No Prior Lung History...9 hr flight from here 5 days ago......Not feeling well last 3 days shortness of breath.....with at the end blood coming from the mouth....Usually very fit...they have taken ex-rays now ??/ XXXXX from Coffs Harbour Aus.
Posted Sun, 29 Sep 2013 in Lung and Chest disorders
 
 
Answered by Dr. Gyanshankar Mishra 36 minutes later
Brief Answer:
It seems to be due to barotrauma related to flight

Detailed Answer:
Hi,
Thanks for posting the query on XXXXXXX After going through your query, I would like to comment the following:

1. Broadly speaking, blood in the lungs may be hemothorax or pulmonary hemorrhage i.e. diffuse alveolar hemorrhage and blood in the mouth is may be due to hemoptysis.

2. It would be helpful, if you could let me know, what exactly the doctors have said to you/ xray findings / medical diagnosis as per the doctors.

3. Blood in the lungs if it is localised responds to a treatment in a better way compared to the generalised or diffuse blood in the lungs. There are a variety of causes for the condition , the common ones in this case could be related to barotrauma or infective etiologies.

4. Oxygen saturation of the blood is an important parameter, and an oxygen saturation above 90 % means a good progress is possible in the disease course and chances of recovery are bright in such cases.

5. Along with it antibiotics may have been prescribed.

6. If you could let me know regrading the medical diagnosis of the condition as per the doctors, then it will help me to comment a bit in detail.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Have blood in lungs, no damage and no lung history. Blood coming from mouth, taken X-ray. Suggest? 24 hours later
Hello Dr Gyanshankar,
Having spoke with my wife Sangwian Hookway from her Hospital bed in Burium Private Hospital Thailand...From the X-rays they were able to see that the left lung was all white...They have given her O2 with the tube up the nose and full mask for a while about every 4 hrs only.
They have ad mistered antibiotics and a cough mixture....They have not ruled out TB at this stage as they haven’t got back blood test results...Although it seems unlikely to be TB as not here in AUST.
It seems that increased O2 may help as they are not giving her saturation of 90% O2 by the sounds of things ...and maybe 100 mg of aspro x 2 daily might help to avoid any clots travelling to other parts of the body. WHAT Do you think????
They will be carrying out an Ultrasound test within the hour.
How long does it take to recover from this condition? There has been some improvement this morning also reported a slight fever or temp. rise in the night
What precautions should she take when flying in the future?
Is it a good idea to take aspro before flying??
 
 
Answered by Dr. Gyanshankar Mishra 3 hours later
Brief Answer:
Seems to be acute lung injury at present.

Detailed Answer:
Hi,
Thanks for the follow up.

1. The condition seems to be acute lung injury (ALI) at present. She needs to be investigated in detail regarding the cause of that. May be if possible, a HRCT scan thorax will help.

2. The management is good respiratory support (oxygen with reservoir bag or NIV support if required) along with adequate antibiotic cover and strict rest /hydration.

3. It does not look like TB from the clinical picture.

4. Ultrasound helps rule out presence of fluid.

5. Normally a good clinical response may be seen in 5 to 7 days if the disease etiology has been found and adequate treatment has been initiated.

6. After recovery its better to avoid air travel for atleast 4 weeks and get the clinical opinion of a pulmonologist regarding the same. Oxygen saturation and Xray findings along with clinical assessment is required for determining the fitness for air travel.

7. Pulmonary embolism needs to be ruled out. Normally aspirin is not recommended before flight but if required LMW heparin may be administered in high risk cases.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist


Above answer was peer-reviewed by
 
Follow-up: Have blood in lungs, no damage and no lung history. Blood coming from mouth, taken X-ray. Suggest? 10 hours later
Thankyou again for your reply,
The Hopital on your advice have uped the O2 satuation to 90% with Sangwian wearing a mask most of the time.
The Doctor attending her maintains there was not a blood clot ,or XXXXXXX or that her lung prob. is related to the flight even though the systoms as I've now learnt only apparent the follow day after arrival in Bangkok.
From the Ulta sound results ..not sure as Sangwian maintained she was told 3% fluid only now.
He maintains the infection in the lungs is too extensive and that some other reasons has caused the infection ..which looks simular to Nemonia? or TB.
They will carry out the 3rd Saliva test today for TB.
Her recvery is very slow but this Hospital does have access to good Machinary and good Antibiotics at least ,I just wish she was here where I have Private Health Ins and a better Hospital System......
What would be the best Antibiotic for her to be on?
Any othjer thoughts or requests............ thanks XXXXX
 
 
Answered by Dr. Gyanshankar Mishra 3 hours later
Brief Answer:
Oxygen saturation parameter needs monitoring.

Detailed Answer:
Hi,
Thanks for the follow up.

1. Oxygen saturation is the percentage of oxygen as measured by pulse oxymeter or on ABG analysis. This parameter more than 90% is a good sign. FiO2 is the fraction of Oxygen in inspired air. It is the FiO2 that we can change,The FiO2 should be such that the patient's oxygen saturation as measured should be more than 90 %.

2. By the looks of it, it seems that the diagnosis is an infective consolidation and the saliva testing is being sent for bacterial and viral testing.

3. The choice of antibiotics depends on the local guidelines since the strains and resistance patterns of the organisms differ by place. Hence the local physicians will be in a better position to decide on the antibiotics to be used.

4. If required they can go for a hrct scan thorax to assist them in the diagnosis.


I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
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