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Bronchoscopy images from left lower lobe and bronchus intermedius (left to right) confirm hemosiderosis, evidence of old hemorrhage.

Bronchoscopy images from left lower lobe and bronchus intermedius (left to right) confirm hemosiderosis, evidence of old hemorrhage.

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Figure 1. MRI of the lower extremities shows edema within the popliteal...
TABLE 1 . Complications of Group A Beta- Hemolytic Streptococcal Infections
Figure 2. CT scan with IV contrast: Inspiration and expiration images...
Figure 3. Chest CT with angiography demonstrates ground glass...
Figure 4. Bronchoscopy images from left lower lobe and bronchus...
Index of Suspicion
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  • Sep 2014
We invite readers to contribute case presentations and discussions. Please use the Submit and Track My Manuscript link on the Pediatrics in Review homepage: http://pedsinreview.aappublications.org . A 6-year-old girl presents with bilateral lower leg swelling, progressive fatigue, and ultimately, refusal to walk secondary to severe pain, which beg...
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... tomography of the chest with angiography demonstrates ground glass opacities suggestive of hemosiderosis or hemor- rhage ( Figure 3). Bronchoscopy confirms hemosiderosis (Figure 4), evidence of an old hemorrhage. Additional evaluation leads to diagnosis. ...

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Association between idiopathic pulmonary hemosiderosis and celiac disease in pediatric patients: A scoping review of the literature over the past 50 years
Article
  • Jan 2022
  • PEDIATR PULM
Introduction: Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of diffuse alveolar hemorrhage (DAH), the mechanism of which is currently unknown. Nearly one-third of pediatric patients with IPH test positive for Celiac disease (CD) serology. Several hypothetical mechanisms have been proposed to unify the coexistence of these two entities, also referred to as Lane-Hamilton syndrome (LHS). Method: This manuscript is a scoping review of the medical literature. Medline, Embase, and PubMed Central databases were searched between 1971 and 2021 with appropriate search words to identify all cases of pediatric LHS. Results: A total of 20 manuscripts with 23 pediatric patients with LHS were identified. The mean age was 11 years, and 13/23 (56.5%) of the children were boys. Hemoptysis was present in 57% of patients during diagnosis. Bronchoscopy with bronchoalveolar lavage demonstrating hemosiderin laden macrophages was the primary mode of diagnostic confirmation. Only three patients underwent lung biopsy. Any significant GI symptom was reported in a minority of patients (22%). Iron deficiency anemia on presentation was described in 83% of children. The majority of patients were malnourished. Serology for CD was positive in all patients, as was the histopathologic analysis of the small bowel biopsy. No patients had any other autoantibody positivity. The introduction of gluten free diet (GFD) was associated with a positive response in 20/23 patients. Conclusion: All pediatric patients with IPH should undergo screening for CD. Low serum ferritin in patients with IPH could be suggestive of coexisting CD. Strict GFD should be tried as the initial therapy. This article is protected by copyright. All rights reserved.
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