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Pulmonary Hemorrhage in a Patient with Acute Coronary Syndrome

Gabriel C. Fernández-Perez1, María Vázquez2, Carlos Delgado1, María Velasco1, Ana Vázquez-Lima3 and José Rodríguez-Pérez3

1 Department of Radiology, Povisa Medical Center, Salamanca St. 5, Vigo 36211, Pontevedra, Spain.
2 Department of Cardiology, Povisa Medical Center, Vigo, Pontevedra, Spain.
3 Intensive Care Unit, Povisa Medical Center, Vigo, Pontevedra, Spain.


Figure 1
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  		Fig. 1A —67-year-old man with acute coronary syndrome. Chest radiograph obtained at hospital admission shows normal findings.

 

Figure 2
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  		Fig. 1B —67-year-old man with acute coronary syndrome. Chest radiograph 24 hours after percutaneous coronary angioplasty shows bilateral alveolar infiltrates with central distribution and thickened minor fissure. Cardiac silhouette is similar to that in A. Radiographic differentiation of diffuse alveolar hemorrhage from hydrostatic pulmonary edema is difficult.

 

Figure 3
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  		Fig. 1C —67-year-old man with acute coronary syndrome. Chest radiograph 48 hours after percutaneous coronary angioplasty shows extensive bilateral diffuse confluent acinar ground-glass areas of increased pulmonary consolidation. Despite therapy for cardiac failure, radiologic findings are not altered.

 

Figure 4
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  		Fig. 1D —67-year-old man with acute coronary syndrome. Chest radiograph 4 days after percutaneous coronary angioplasty shows persistent extensive bilateral alveolar infiltrates with no change. Presence of hemoptysis and sparing of peripheral pulmonary parenchyma are clues to diagnosis.

 

Figure 5
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  		Fig. 1E —67-year-old man with acute coronary syndrome. CT scan several days after D shows ground-glass patch lesions (arrows) due to pulmonary hemorrhage and parenchymal opacifications interpreted as adult respiratory distress syndrome.

 

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