Massive pulmonary haemorrhage due to severe trauma treated with repeated alveolar lavage combined with extracorporeal membrane oxygenation:A case report

BACKGROUND Massive pulmonary haemorrhage can spoil the entire lung and block the airway in a short period of time due to severe bleeding,which quickly leads to death.Alveolar lavage is an effective method for haemostasis and airway maintenance.However,patients often cannot tolerate alveolar lavage due to severe hypoxia.We used extracorporeal membrane oxygenation(ECMO)to overcome this limitation in a patient with massive pulmonary haemorrhage due to severe trauma and succeeded in saving the life by repeated alveolar lavage.CASE SUMMARY A 22-year-old man sustained multiple injuries in a motor vehicle accident and was transferred to our emergency department.On admission,he had a slight cough and a small amount of bloody sputum;computed tomography revealed multiple fractures and mild pulmonary contusion.At 37 h after admission,he developed severe chest tightness,chest pain,dizziness and haemoptysis.His oxygen saturation was 68%.Emergency endotracheal intubation was performed,and a large amount of bloody sputum was suctioned.After transfer to the intensive care unit,he developed refractory hypoxemia and heparin-free venovenous ECMO was initiated.Fibreoptic bronchoscopy revealed diffuse and profuse blood in all bronchopulmonary segment.Bleeding was observed in the trachea and right bronchus,and repeated alveolar lavage was performed.On day 3,the patient’s haemoptysis ceased,and ECMO support was terminated 10 d later.Tracheostomy was performed on day 15,and the patient was weaned from the ventilator on day 21.CONCLUSION Alveolar lavage combined with ECMO can control bleeding in trauma-induced massive pulmonary haemorrhage,is safe and can be performed bedside.

Human infection with a novel avian-origin influenza A （H7N9） virus： serial chest radiographic and CT findings

Background Rapidly progressive pneumonia infection with H7N9 virus is a novel disease,and limited information is available concerning serial chest radiographic and computed tomography （CT） findings.The aim of this study was to evaluate the changes in serial radiologic findings in patients with H7N9 pneumonia.Methods The two institutional ethics review boards approved this retrospective study.This study included 10 patients with H7N9 pneumonia.All patients underwent chest radiologic examinations at different time points.Serial radiologic images were systematically analyzed.Results All patients showed abnormal results on initial chest radiography and CT.The initial radiographic abnormalities were unilateral （n=9） and bilateral （n=1）,including ground-glass opacities （GGOs） （n=5） and consolidation （n=5）.The initial CT findings consisted of unilateral （n=6） and bilateral （n=4）,including consolidation （n=10）,GGOs （n=10）,reticular opacities （n=2）,and pleural effusion （n=3）.Follow-up radiologic findings showed rapid development of consolidation or GGOs within two weeks after illness onset.Pneumomediastinum with secondary subcutaneous emphysema and pneumothorax were noted in two patients.Follow-up high resolution computed tomography （HRCT） after two weeks showed slow improvement in both size and opacity of the lesions.On HRCT after discharge,patients had substantial residual lesions such as irregular linear opacities,reticular opacities,parenchymal bands,traction bronchiectasis,and cystic lesions.Conclusions The most common radiologic findings at presentation are multifocal or diffuse areas of consolidation and GGOs in H7N9 pneumonia.HRCT in sequence can show more changes in rapid progression of disease and a slow decrease of both size and opacity of the lesions plays an important role in the evaluation of H7N9 pneumonia.