Case of the Month February 2017 Page 2

Hospital Course

  • Over the hospital course, the patient's condition worsened and he developed a slightly bloody cough

Above: Frontal radiograph of the chest demonstrates progressive bilateral, diffuse airspace opacities.  Differential considerations include fulminant lung infection, developing acute respiratory distress syndrome, and diffuse alveolar hemorrhage. For a larger image, please click on Edema 5  

Below:  CT of the sinuses without contrast demonstrate severe right maxillary sinusitis and mild anterior ethmoid sinusitis.  No osseous erosions are identified. For larger images, please click on Edema 6 , Edema 7  and Edema 8


Hospital Course Continued:

  • Transferred to ICU due to hypoxemic respiratory failure and intubated for suspected vasculitis
  • Started on dialysis for progressive renal failure

Below: Frontal radiograph of the chest demonstrates severe worsening of diffuse bilateral consolidations consistent with diffuse alveolar hemorrhage. For a larger image, please click on Edema 9


Hospital Course:

  • Progressive hypoxemic respiratory failure and continued bloody secretions

Differential Diagnosis?

  •  Pulmonary Vasculitides
    • Granulomatosis with polyangiitis
    • Microscopic polyangiitis
    • Churg Strauss
  • Connective Tissue Disorders
    • Lupus
    • Mixed connective disease
  • Coagulative disorder
  • Medication toxicity
  • Complications of widespread pulmonary malignancy
  • Pulmonary hemosiderosis


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