58M C C Blood tinged sputum and dyspnea

58/M C. C. : Blood tinged sputum and dyspnea after strenuous exercise PMHx. : none

2010 -07 -20 outside chest CT

2010 -08 -06 Chest CT (contrast) + 3 D

Bronchoscopy (2010 -11 -03) Title

Bronchoscopy (2010 -11 -03) Bronchial washing negative CT상 bleeding focus및 endobronchial lesion이 의심되었던 LLL posterobasal segment중 LB 10의 subsegemental branch에서 hemoptysis가 관찰되나 특별 한 endobronchial lesion은 관찰되지 않았음. Bronchial washing, "LLL basal", all negative - Cytology: Negative for malignant cells - Gram stain: Rare(<1) WBC , No Bacteria - 일반미생물: no microorganism isolated - M. tuberculosis Complex: Negative for M. tuberculosis

2015 -11 -26 Chest HRCT 2015 -11 -26

2018 -12 -19 chest HRCT 2018 -12 -19

2015 -11 -26 Chest HRCT Title 2018 -12 -19 chest HRCT CBC including eosinophil count, coagulation lab, sputum culture: all negative

58/M C. C. : Blood tinged sputum and dyspnea after strenuous exercise (*amateur marathoner) PMHx. : none

over 5 -6 km/hr

Exercise-Induced Pulmonary Hemorrhage (EIPH) Occurs frequently in Thoroughbred horses; almost all thoroughbreds demonstrate bleeding in the lower respiratory tract after a race. Lung 2006; 184: 331– 333, Tuberc Respir Dis 2015; 78: 375– 379 Veterinary Medicine-Research and Reports, 2016; 7: 133– 148

Exercise-Induced Pulmonary Hemorrhage (EIPH) Occurs frequently in Thoroughbred horses; almost all thoroughbreds demonstrate bleeding in the lower respiratory tract after a race. Exercise-induced pulmonary hemorrhage/edema (EIPH/EIPE) in human. Marathon runners, triathletes, cyclists, and swimmers. Clinical manifestations: asymptomatic, dyspnea, hemoptysis, epistaxis Mechanism: capillary wall tearing / remodeling of small pulmonary veins. Exercise elevates pulmonary capillary pressures, can affect the integrity of the blood-gas barrier. With extreme exertion, these changes result in increased permeability. High pulmonary vascular pressure results in pulmonary vein wall remodeling, and diminished vein lumen diameter. Image findings - Radiograph: patchy infiltration in both lower lung fields - CT: multifocal diffuse, patchy ground glass opacity and interlobular septal thickening on both lungs permeability pulmonary edema or pulmonary hemorrhage were compatible Lung 2006; 184: 331– 333, Tuberc Respir Dis 2015; 78: 375– 379 Veterinary Medicine-Research and Reports, 2016; 7: 133– 148

Exercise-Induced Pulmonary Hemorrhage (EIPH) Five days after avoiding exercise Two weeks after avoiding exercise Management: lack of information of a medication or management in the treatment and prevention of EIPH/EIPE in humans.