Diffuse alveolar hemorrhage secondary to antiphospholipid syndrome

Case contributed by Bruno Di Muzio


Presented with severe shortness of breath and hemoptysis for 3 days. Known patient with antiphospholipid syndrome and multiple PEs in the past. Pulmonary embolism?

Patient Data

Age: 45 years
Gender: Male

Patchy air space opacities scattered bilaterally through both lungs are nonspecific and have a broad differential, which, in this clinical scenario, has alveolar hemorrhage as favored. No evidence of significant pleural effusions. Cardiomediastinal contours are of limited assessment in this projection.

There is diagnostic contrast opacification of the pulmonary arteries and no evidence of pulmonary embolus. A few prominent mediastinal lymph nodes are nonspecific, measuring up to 1.0 cm in their short axis, being of uncertain clinical significance. Confluent foci of groundglass opacities scattered throughout both lungs, relatively sparing the periphery. Pleural spaces are clear. Airways are normal. There is a gastric balloon. The remainder of the imaged abdomen is unremarkable.

Case Discussion

This patient underwent bronchoscopy lavage which showed alveolar hemorrhage and neutrophilia. The lavage cultures came negative. 

Patients with the antiphospholipid syndrome may rarely present, as in this case, with diffuse alveolar hemorrhage. This is explained by disruption of the alveolar-capillary basement membrane due to inflammation of the arterioles, venules, or alveolar capillaries. 

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