2012 Volume 34 Issue 6 Pages 547-551
Background. Diffuse alveolar hemorrhage (DAH) is a severe condition and is often difficult to diagnose and treat. Purpose. We retrospectively reviewed records of patients with DAH and evaluated the clinical features. Methods. We investigated 11 cases of DAH hospitalized at Kyoto Medical Center in Japan from April 2006 to April 2011. These cases were diagnosed by bronchoalveolar lavage (BAL) and on the basis of their clinical manifestations. Results. Of the 11 patients investigated in this study, 7 were men and 4 were women. The mean age was 69.5 year. Hemoptysis was absent in 4 patients. Eight patients had respiratory failure and 7 underwent mechanical ventilation. The etiologies included microscopic polyangiitis (MPA) in 5 patients, systemic lupus erythematosus (SLE) in 1, and aplastic anemia in 1. The etiologies in the other patients were unknown. In all cases, chest computed tomography (CT) revealed increased intensity in multiple lobe. Lung biopsy was not performed because of serious respiratory failure and the risk of bleeding. All patients received steroid therapy, and a higher steroid dose was administered to 9 patients. Of the 11 patients in the study, 9 survived and 2 died (mortality rate: 18%). Conclusion. The underlying causes of DAH are varied, but MPA was the most frequent etiology observed in this study. BAL was useful in diagnosis because hemoptysis, a typical symptom, was absent in some cases. In many cases, DAH is caused by vasculitis and collagen vascular disease that is responsive to steroid therapy. Hence, it is very important to use BAL for the diagnosis of DAH.
