title: Occult alveolar haemorrhage in pulmonary veno-occlusive disease.
abstract: Pulmonary veno-occlusive disease (PVOD) is a rare cause of pulmonary arterial hypertension that affects predominantly post-capillary pulmonary vessels. A major concern with PVOD is the poor response to available therapies and the risk of pulmonary oedema with continuous intravenous epoprostenol. The present authors hypothesised that alveolar haemorrhage may be a characteristic feature of pulmonary veno-occlusive disease, as compared with other forms of pulmonary arterial hypertension that predominantly involve pre-capillary pulmonary arteries. This paper reports a series of 19 patients with either PVOD (n = 8) or idiopathic pulmonary arterial hypertension (IPAH; n = 11) who underwent bronchoalveolar lavage. Cytological analyses were performed and differential counts were made on Perls-stained preparations. The Golde score was used to assess alveolar haemorrhage. As compared with IPAH, PVOD was characterised by a higher percentage of haemosiderin-laden macrophages (40+/-37 versus 3+/-6%), resulting in elevated Golde scores (81+/-88 versus 4+/-10). It was concluded that occult alveolar haemorrhage is a common feature of pulmonary veno-occlusive disease. Detecting occult alveolar haemorrhage may be of interest in the diagnostic approach of pulmonary veno-occlusive disease.
authors.affiliation: Centre des Maladies Vasculaires Pulmonaires, Service de Pneumologie, Hôpital Antoine Béclère, Université Paris-Sud, Clamart, France.
authors.forename: A
authors.initials: A
authors.lastname: Rabiller
authors.forename: X
authors.initials: X
authors.lastname: Jaïs
authors.forename: A
authors.initials: A
authors.lastname: Hamid
authors.forename: A
authors.initials: A
authors.lastname: Resten
authors.forename: F
authors.initials: F
authors.lastname: Parent
authors.forename: R
authors.initials: R
authors.lastname: Haque
authors.forename: F
authors.initials: F
authors.lastname: Capron
authors.forename: O
authors.initials: O
authors.lastname: Sitbon
authors.forename: G
authors.initials: G
authors.lastname: Simonneau
authors.forename: M
authors.initials: M
authors.lastname: Humbert
mesh_terms: D000328:Adult; D018893:Bronchoalveolar Lavage; D001999:Bronchoscopy; D016009:Chi-Square Distribution; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011650:Pulmonary Alveoli; D011668:Pulmonary Veno-Occlusive Disease / Q000150:complications*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric