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Occult alveolar haemorrhage in pulmonary veno-occlusive disease

¹ Centre des Maladies Vasculaires Pulmonaires, Service de Pneumologie. ² Service de Radiologie, and ³ Service d'Anatomie Pathologique, Unité Propre de Recherche de l'Enseignement Supérieur EA2705, Hôpital Antoine Béclère, Université Paris-Sud, Clamart, France.

CORRESPONDENCE: M. Humbert, Service de Pneumologie, Hôpital Antoine Béclère, 157, Rue de la Porte de Trivaux, 92140 Clamart, France. Fax: 33 146303824. E-mail: marc.humbert{at}abc.aphp.fr

Keywords: Alveolar haemorrhage, bronchoalveolar lavage, pulmonary arterial hypertension, pulmonary veno-occlusive disease

Received: May 6, 2005
Accepted August 23, 2005

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.

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