Clinical Image - Volume 2 - Issue 3

Alveolar Hemorrhage: The typical aspect

Habib Chorfa sara; El Ouali Ibtissam* ; Drissi Maniani Abdelilah; Sninat Sanae; Jroundi Laila; Laamrani FZ

Emergency radiology departement, Ibn SINA University Hospital of Rabat, Morocco.

Received Date : Apr 06, 2022
Accepted Date : May 11, 2022
Published Date: May 23, 2022
Copyright:© Ibtissam El Ouali 2022

*Corresponding Author : El Ouali Ibtissam, Emergency radiology departement, Ibn SINA University Hospital of Rabat .Morocco, Tel:+212610959070.


Keywords: Hemoptysis; bicytopenia; CT scan; frosted glass.

Clinical Image

We report the case of a 56 year-old patient, with a history of leukemia under treatment, who presented to the emergency room with respiratory distress associated to hemoptysis, chest pain and dyspnea NYHA stage IV with a decreased oxygen level to 85% on room air, a CBC revealed a bicytopenia. Plain radiograph showed a bilateral, peri hilar and basal alveolar syndrome, comparable to that observed in pulmonary oedema and thoracic CT scan showed bilateral and symmetrical hilifugal central ground glass areas. Alveolar hemorrhage is defined as diffuse bleeding of pulmonary capillary in distal airspaces. Rapid diagnosis is required for an efficient therapeutical management of the hemorrhage and its cause. Imaging reveals bilateral areas of alveolar condensation and/or ground glass. Negative findings, such as the absence of pleural effusion, adenopathy, cardiomegaly and signs of pulmonary hypertension (Figures 1+2) are very crucial to the diagnosis of alveolar hemorrhage. The pink appearance with siderophagus in the bronchoalveolar lavage confirms the diagnosis.

The radiographic differential diagnosis arises with cardiogenic and lesional pulmonary oedema as well as certain diffuse infections, in particular Pneumocystis carinii pneumopathy in immunocompromised subjects

Figure 1: Chest X-ray showing bilateral interstitial syndrome.

Figure 2: Chest CT axial (A) and coronal (B) section images revealing bilateral, flaky, centrally distributed ground glass foci sparing the sub pleural space in favor of alveolar hemorrhage.