Microsoft Word - NEF101BF

Masanobu Miyazaki, MD, Department of Internal Medicine VII, School of Medicine, Tokai University, Isehara, Kanagawa 259-11 (Japan) Dear Sir, This is the first report of aortobronchial fistula complication in a hemodialysis patient. The patient was 56-year-old male who underwent hemodialysis for 10 years, and complicated aortobronchial fistula with an aortic aneurysm. He died due to massive hemoptysis on admission. It was difficult to make the diagnosis because of a small amount of intermittent hemoptysis before admission and lack of evidence of an aneurysm on the chest X ray. The purpose of this report is to draw attention to the little known disorder, and to stress the importance of differential diagnosis of hemoptysis in hemodialysis patients. Case Report A 56-year-old male was admitted to the emergency center in Tokai University Hospital because of massive hemoptysis. He had a long history of hypertensive renal disease, and hemodialysis was started 10 years ago due to end-stage renal failure. Hemodialysis was performed 3 times a week. Three weeks before admission he noticed left back pain and a small amount of intermittent hemoptysis. Chest X-ray films disclosed no abnormalities. The left back pain worsened 2 days before admission. He suddenly developed hemoptysis with 300 ml of fresh blood in the morning of admission, and was immediately transferred to our hospital. Physical examination revealed anemic conjunctive palpebrae, and moist rale was auscultated in the left lower lung field. Blood pressure was 168/90 mm Hg. No abnormalities in the abdomen nor peripheral edema were found. Laboratory examination disclosed leukocyte count of 12,100/mm3 with normal differentiation, and hemoglobin 6.3 g/dl with normochromic normocyte. Blood urea nitrogen was 48 mg/dl and serum creatinine 6.8 mg/dl. The value of potassium was 5.9 mEq/1 and phosphate 4.7 mg/dl. Serum albumin was 3.2 mg/dl, and glucose,