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Exercise-Induced Pulmonary Hemorrhage in Amateur Marathon Runner

This case study explores a 58-year-old amateur marathon runner presenting with blood-tinged sputum and dyspnea after exercise, reminiscent of Exercise-Induced Pulmonary Hemorrhage (EIPH). The text discusses the clinical manifestations, mechanism, and imaging findings associated with EIPH in humans, drawing parallels with EIPH observed in Thoroughbred horses. It details the patient's medical history, diagnostic procedures, and hospital course, shedding light on the challenges of managing and preventing EIPH in human athletes.

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Exercise-Induced Pulmonary Hemorrhage in Amateur Marathon Runner

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  1. 대한흉부영상의학회월례집담회증례발표 January 2019 분당서울대병원 신 윤 주

  2. 58/M C.C.: Blood tinged sputum and dyspnea after strenuous exercise PMHx.: none

  3. 2010-07-20 outside chest CT

  4. 2010-08-06 Chest CT (contrast) + 3D

  5. Title Bronchoscopy (2010-11-03)

  6. Bronchoscopy (2010-11-03) Bronchial washing negative CT상 bleeding focus및endobronchial lesion이의심되었던 LLL posterobasal segment중LB10의subsegemental branch에서 hemoptysis가관찰되나특별한endobronchial lesion은관찰되지않았음. 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

  7. 2015-11-26 Chest HRCT 2015-11-26

  8. 2018-12-19 chest HRCT 2018-12-19

  9. 2015-11-26 Chest HRCT Title 2018-12-19 chest HRCT CBC including eosinophil count, coagulation lab, sputum culture: all negative

  10. 58/M C.C.: Blood tinged sputum and dyspnea after strenuous exercise (*amateur marathoner) PMHx.: none

  11. Hospital course 2010-07-20: 마라톤운동. 2년전부터 호흡이답답함, 정상운동을과하게하면호흡곤란증가, 간혹혈담 2010-08-03: hemoptysis 는 없음 2010-11-02: 최근운동하면서마라톤 후 혈담, 이후호전 2010-11-23: no hemoptysis기침, 가래 2015-11-24: 심한 운동후 : 마라톤, 산악 마라톤 : 100 k 울트라 혈담이 간혹 나옴 : 22일 2018-12-11: 그동안 운동을 계속함, 울트라 마라톤 100km, 9월 300km 달리는 중 심하게 운동하면BTS, 이후 서서히 감소함, 대회중 BTS 2019-01-10: 울트라 마라톤 100km,  하루 15-20km, 강도가 낮아 혈담 -

  12. over 5-6km/hr

  13. 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

  14. 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

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

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