Chest
Volume 101, Issue 4, April 1992, Pages 1150-1152
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Selected Reports
Spontaneous Pulmonary Hemorrhage Following Coronary Thrombolysis

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Excessive bleeding is a major concern during the administration of thrombolytic therapy. Although the great majority of these events occur at sites of vascular interruption, major gastrointestinal, retroperitoneal, genitourinary, and central nervous system hemorrhage are known to occur. We present a patient who developed spontaneous pulmonary hemorrhage during thrombolytic therapy. Lack of recognition that the lungs too may be a site of spontaneous hemorrhage during thrombolytic therapy may lead to a considerable diagnostic and therapeutic delay. Pulmonary hemorrhage should be considered in the differential diagnosis of patients who receive thrombolytic therapy in whom new roentgenographic pulmonary infiltrates present accompanied by decreases in hematocrit va.lue.

Section snippets

CASE REPORT

A 52-year-old man presented to St. Vincent's Hospital with an acute anterior wall myocardial infarction. Chest pain had begun approximately one half hour prior to presentation. Physical examination on admission demonstrated blood pressure of 130/80 mm Hg, pulse rate of 84 beats per minute, and respiratory rate of 16 per minute. Chest examination revealed clear heart sounds, an atrial gallop, and no murmurs or rubs. Rales were heard at both lung bases. The ECG was significant for an acute

DISCUSSION

The majority of complications involved with thrombolytic therapy are primarily related to bleeding. The first TIMI trial reported bleeding, ecchymosis, or hematoma at the catheterization site in approximately two thirds of the patients. A major bleeding event defined as a reduction of hemoglobin of 5 g/dl or more or any intracranial bleed occurred in about 15 percent of patients studied.1 Our patient sustained a 40 percent reduction in hematocrit value during the 48 h period after

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There are more references available in the full text version of this article.

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