Hemoptysis pathophysiology: Difference between revisions

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==Overview==
==Overview==
[[Lung]] has two main [[vascular]] systems that include [[Lung|pulmonary]] circulation and [[Bronchiole|bronchial]] circulation. There are multiple [[Anastomosis|anastomoses]] between [[Lung|pulmonary]] and [[Bronchial artery|bronchial arteries]] which create [[Physiology|physiologic]] right to left [[Shunt (medical)|shunts]]. [[Blood]] in the hemoptysis is mostly originated from the [[Lung]]. However, it could be from the [[Gastrointestinal tract|gastrointestinal system]] as well. Primary origin of the [[blood]] comes from [[Bronchial artery|bronchial arteries]]. However, other sources of [[bleeding]] might be [[Pulmonary circulation|pulmonary vessels]], [[aorta]], [[intercostal]], [[Coronary circulation|coronary]], [[Chest|thoracic]], and phrenic [[Artery|arteries]]. Hemoptysis is an important [[symptom]] that has different etiologies and pathogenesis mechanisms. Hemoptysis may happen following [[infarction]] and [[ischemia]] of [[Lung|pulmonary]] parenchyma as seen in [[pulmonary embolism]], [[vasculitis]], and [[Infection|infections]]. Another mechanism of hemoptysis is [[vascular]] engorgement with erosion as seen in [[bronchitis]], [[bronchiectasis]], and toxic exposure to [[cigarette]] and other [[Irritation|irritants]]. In some cases underlying cause can not be identified and they are considered as [[idiopathic]]. However, they might present with massive hemoptysis. There are multiple conditions that are associated with hemoptysis which include [[granulomatosis with polyangiitis]], [[sarcoidosis]], [[immunodeficiency]], and indoor ice hockey play.


==Pathophysiology==
==Pathophysiology==


===Physiology===
===Physiology===
* Lung has two main vascular systems that include pulmonary circulation and bronchial circulation.  
* [[Lung]] has two main [[vascular]] systems that include [[Lung|pulmonary]] circulation and [[Bronchiole|bronchial]] circulation.  
* There are multiple anastomoses between pulmonary and bronchial arteries which create physiologic right to left shunts.
* There are multiple [[Anastomosis|anastomoses]] between [[Lung|pulmonary]] and [[Bronchial artery|bronchial arteries]] which create [[Physiology|physiologic]] right to left [[Shunt (medical)|shunts]].
** [[Pulmonary circulation]]  
** [[Pulmonary circulation]]  
*** It provides gas exchange where deoxygenated blood enters the lungs through pulmonary arteries and oxygenated blood returns to circulation through pulmonary veins.
*** It provides [[gas exchange]] where deoxygenated [[blood]] enters the [[Lung|lungs]] through [[Pulmonary artery|pulmonary arteries]] and [[oxygenated blood]] returns to [[Circulatory system|circulation]] through [[pulmonary veins]].
*** Pulmonary arteries  
*** [[Pulmonary artery|Pulmonary arteries]]
*** Pulmonary veins
*** [[Pulmonary veins]]
[[image:2119 Pulmonary Circuit.jpg|thumb|700 px|left|Illustration from Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013. By OpenStax College - Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013., CC BY 3.0,<ref name="urlFile:2119 Pulmonary Circuit.jpg - Wikimedia Commons">{{cite web |url=https://commons.wikimedia.org/w/index.php?curid=30148269 |title=File:2119 Pulmonary Circuit.jpg - Wikimedia Commons |format= |work= |accessdate=}}</ref>]]
[[image:2119 Pulmonary Circuit.jpg|thumb|700 px|left|Illustration from Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013. By OpenStax College - Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013., CC BY 3.0,<ref name="urlFile:2119 Pulmonary Circuit.jpg - Wikimedia Commons">{{cite web |url=https://commons.wikimedia.org/w/index.php?curid=30148269 |title=File:2119 Pulmonary Circuit.jpg - Wikimedia Commons |format= |work= |accessdate=}}</ref>]]
[[image:Pulmonary Blood Circulation.png|thumb|700 px|left|This slide shows the arterial and venous blood circulation of the pulmonary system. By Artwork by Holly Fischer - http://open.umich.edu/education/med/resources/second-look-series/materials - Respiratory Tract Slide 20, CC BY 3.0,<ref name="urlFile:Pulmonary Blood Circulation.png - Wikimedia Commons">{{cite web |url=https://commons.wikimedia.org/w/index.php?curid=24367137 |title=File:Pulmonary Blood Circulation.png - Wikimedia Commons |format= |work= |accessdate=}}</ref>]]
[[image:Pulmonary Blood Circulation.png|thumb|700 px|left|This slide shows the [[Artery|arterial]] and [[Vein|venous]] [[Circulatory system|blood circulation]] of the [[Lung|pulmonary]] system. By Artwork by Holly Fischer - http://open.umich.edu/education/med/resources/second-look-series/materials - Respiratory Tract Slide 20, CC BY 3.0,<ref name="urlFile:Pulmonary Blood Circulation.png - Wikimedia Commons">{{cite web |url=https://commons.wikimedia.org/w/index.php?curid=24367137 |title=File:Pulmonary Blood Circulation.png - Wikimedia Commons |format= |work= |accessdate=}}</ref>]]
<br style="clear:left" />
<br style="clear:left" />
:* Bronchial vessels
:* [[Bronchial vessels]]
::* Bronchial vessels provide blood and nutrients to the bronchi and connective tissue of the lungs. They supply blood to the respiratory bronchioles and the visceral pleura of the lung.
::* [[Bronchial vessels]] provide [[blood]] and [[Nutrient|nutrients]] to the [[Bronchus|bronchi]] and [[connective tissue]] of the [[Lung|lungs]]. They supply [[blood]] to the [[Respiratory bronchiole|respiratory bronchioles]] and the [[visceral pleura]] of the [[lung]].
::* Bronchial arteries carry oxygenated blood to the lung tissues. They are arised from the thoracic aorta. There are usually two branches to the left lung and one to the right lung.
::* [[Bronchial artery|Bronchial arteries]] carry [[Blood|oxygenated blood]] to the [[lung]] tissues. They are arised from the thoracic [[aorta]]. There are usually two branches to the left [[lung]] and one to the right [[lung]].
::* Bronchial veins return the deoxygenated blood from the lung tissues to the systemic circulation. The right side drains into the azygos vein and the left side drains into the left superior intercostal vein or the accessory hemiazygos vein.
::* [[Bronchial veins]] return the deoxygenated [[blood]] from the [[lung]] tissues to the [[systemic circulation]]. The right side drains into the [[azygos vein]] and the left side drains into the [[Superior intercostal vein|left superior intercostal vein]] or the [[accessory hemiazygos vein]].
{{#ev:youtube|K57qjYYjgIY}}
{{#ev:youtube|K57qjYYjgIY}}
===Pathogenesis===
===Pathogenesis===
* Hemoptysis is an important symptom that has different etiologies and pathogenesis mechanisms.<ref name="urlHemoptysis - Clinical Methods - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK360 |title=Hemoptysis - Clinical Methods - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
* Hemoptysis is an important [[symptom]] that has different etiologies and pathogenesis mechanisms.<ref name="urlHemoptysis - Clinical Methods - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK360 |title=Hemoptysis - Clinical Methods - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
* Blood in the hemoptysis is mostly originated from the pulmonary vasculature. However, it could be from the gastrointestinal system as well.
* [[Blood]] in the hemoptysis is mostly originated from the [[Lung]]. However, it could be from the [[Gastrointestinal tract|gastrointestinal system]] as well.<ref name="Andersen2016">{{cite journal|last1=Andersen|first1=P. E.|title=Imaging and interventional radiological treatment of hemoptysis|journal=Acta Radiologica|volume=47|issue=8|year=2016|pages=780–792|issn=0284-1851|doi=10.1080/02841850600827577}}</ref>
* Hemoptysis could be happened following infarction and ischemia of pulmonary parenchyma. It is seen in following conditions:
* Primary origin of the [[blood]] comes from [[Bronchial artery|bronchial arteries]].<ref name="IttrichKlose2014">{{cite journal|last1=Ittrich|first1=H.|last2=Klose|first2=H.|last3=Adam|first3=G.|title=Radiologic Management of Haemoptysis: Diagnostic and Interventional Bronchial Arterial Embolisation|journal=RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren|volume=187|issue=04|year=2014|pages=248–259|issn=1438-9029|doi=10.1055/s-0034-1385457}}</ref><ref name="NoëJaffé2011">{{cite journal|last1=Noë|first1=G.D.|last2=Jaffé|first2=S.M.|last3=Molan|first3=M.P.|title=CT and CT angiography in massive haemoptysis with emphasis on pre-embolization assessment|journal=Clinical Radiology|volume=66|issue=9|year=2011|pages=869–875|issn=00099260|doi=10.1016/j.crad.2011.03.001}}</ref>
** Pulmonary emboli
* Other sources of [[bleeding]] might be:<ref name="SakrDutau2010">{{cite journal|last1=Sakr|first1=L.|last2=Dutau|first2=H.|title=Massive Hemoptysis: An Update on the Role of Bronchoscopy in Diagnosis and Management|journal=Respiration|volume=80|issue=1|year=2010|pages=38–58|issn=1423-0356|doi=10.1159/000274492}}</ref><ref name="GuptaSrivastava2013">{{cite journal|last1=Gupta|first1=Mudit|last2=Srivastava|first2=Deep Narayan|last3=Seith|first3=Ashu|last4=Sharma|first4=Sanjay|last5=Thulkar|first5=Sanjay|last6=Gupta|first6=Rashmi|title=Clinical Impact of Multidetector Row Computed Tomography Before Bronchial Artery Embolization in Patients With Hemoptysis: A Prospective Study|journal=Canadian Association of Radiologists Journal|volume=64|issue=1|year=2013|pages=61–73|issn=08465371|doi=10.1016/j.carj.2011.08.002}}</ref><ref name="NoëJaffé2011">{{cite journal|last1=Noë|first1=G.D.|last2=Jaffé|first2=S.M.|last3=Molan|first3=M.P.|title=CT and CT angiography in massive haemoptysis with emphasis on pre-embolization assessment|journal=Clinical Radiology|volume=66|issue=9|year=2011|pages=869–875|issn=00099260|doi=10.1016/j.crad.2011.03.001}}</ref>
** Vasculitis including:
** [[Aorta]]
***Wegener's granulomatosis
** [[Intercostal arteries]]
**Infections including:
** [[Coronary arteries]]
***Staphylococcus aureus
** Thoracic [[Artery|arteries]]
***Pseudomonas aeruginosa
** The upper and inferior phrenic [[Artery|arteries]]
***Aspergillus fumigatus
** [[Pulmonary circulation|Pulmonary vessels]]
* Hemoptysis may happen following [[infarction]] and [[ischemia]] of [[Lung|pulmonary]] parenchyma. It is seen in following conditions:<ref name="ShigemuraWan2009">{{cite journal|last1=Shigemura|first1=Norihisa|last2=Wan|first2=Innes Y.|last3=Yu|first3=Simon C.H.|last4=Wong|first4=Randolph H.|last5=Hsin|first5=Michael K.Y.|last6=Thung|first6=Hoi K.|last7=Lee|first7=Tak-Wai|last8=Wan|first8=Song|last9=Underwood|first9=Malcolm J.|last10=Yim|first10=Anthony P.C.|title=Multidisciplinary Management of Life-Threatening Massive Hemoptysis: A 10-Year Experience|journal=The Annals of Thoracic Surgery|volume=87|issue=3|year=2009|pages=849–853|issn=00034975|doi=10.1016/j.athoracsur.2008.11.010}}</ref><ref name="ChunMorgan2010">{{cite journal|last1=Chun|first1=Joo-Young|last2=Morgan|first2=Robert|last3=Belli|first3=Anna-Maria|title=Radiological Management of Hemoptysis: A Comprehensive Review of Diagnostic Imaging and Bronchial Arterial Embolization|journal=CardioVascular and Interventional Radiology|volume=33|issue=2|year=2010|pages=240–250|issn=0174-1551|doi=10.1007/s00270-009-9788-z}}</ref>
** [[Pulmonary embolism|Pulmonary emboli]]
** [[Vasculitis]] including:
***[[Granulomatosis with polyangiitis|Granulomatosis with polyangiitis]]
**[[Infection|Infections]] including:
***[[Staphylococcus aureus]]
***[[Pseudomonas aeruginosa]]
***[[Aspergillus fumigatus]]
***The phycomycetes
***The phycomycetes
*Another mechanism of hemoptysis is vascular engorgement with erosion. It is seen in following conditions:
*Another mechanism of hemoptysis is [[vascular]] engorgement with erosion. It is seen in following conditions:<ref name="TomPalevsky2015">{{cite journal|last1=Tom|first1=Lisa M.|last2=Palevsky|first2=Harold I.|last3=Holsclaw|first3=Douglas S.|last4=Trerotola|first4=Scott O.|last5=Dagli|first5=Mandeep|last6=Mondschein|first6=Jeffrey I.|last7=Stavropoulos|first7=S. William|last8=Soulen|first8=Michael C.|last9=Clark|first9=Timothy W.I.|title=Recurrent Bleeding, Survival, and Longitudinal Pulmonary Function following Bronchial Artery Embolization for Hemoptysis in a U.S. Adult Population|journal=Journal of Vascular and Interventional Radiology|volume=26|issue=12|year=2015|pages=1806–1813.e1|issn=10510443|doi=10.1016/j.jvir.2015.08.019}}</ref><ref name="ZhaoWang2017">{{cite journal|last1=Zhao|first1=Tian|last2=Wang|first2=Sini|last3=Zheng|first3=Lili|last4=Jia|first4=Zhongzhi|last5=Yang|first5=Yunjun|last6=Wang|first6=Weiping|last7=Sun|first7=Houzhang|title=The Value of 320-Row Multidetector CT Bronchial Arteriography in Recurrent Hemoptysis after Failed Transcatheter Arterial Embolization|journal=Journal of Vascular and Interventional Radiology|volume=28|issue=4|year=2017|pages=533–541.e1|issn=10510443|doi=10.1016/j.jvir.2017.01.006}}</ref>
** Acute infection such as
** Acute [[infection]] such as:
*** Viral bronchitis
*** Viral [[bronchitis]]
*** Bacterial bronchitis
*** Bacterial [[bronchitis]]
** Chronic infection such as bronchiectasis
** Chronic [[infection]] such as:
** Toxic exposure such as cigarette smoke
*** [[Bronchiectasis]]
 
** Toxic exposure
==Genetics==
*** [[Smoking|Cigarette smoke]]
*[Disease name] is transmitted in [mode of genetic transmission] pattern.
*** [[Asbestos]]
*Genes involved in the pathogenesis of [disease name] include [gene1], [gene2], and [gene3].
* In some cases underlying cause can not be identified and they are considered as [[idiopathic]]. However, they might present with massive hemoptysis.<ref name="pmid17332480">{{cite journal |vauthors=Savale L, Parrot A, Khalil A, Antoine M, Théodore J, Carette MF, Mayaud C, Fartoukh M |title=Cryptogenic hemoptysis: from a benign to a life-threatening pathologic vascular condition |journal=Am. J. Respir. Crit. Care Med. |volume=175 |issue=11 |pages=1181–5 |date=June 2007 |pmid=17332480 |doi=10.1164/rccm.200609-1362OC |url=}}</ref><ref name="pmid11713139">{{cite journal |vauthors=Herth F, Ernst A, Becker HD |title=Long-term outcome and lung cancer incidence in patients with hemoptysis of unknown origin |journal=Chest |volume=120 |issue=5 |pages=1592–4 |date=November 2001 |pmid=11713139 |doi= |url=}}</ref>
*The development of [disease name] is the result of multiple genetic mutations.


==Associated Conditions==
==Associated Conditions==
 
* There are multiple conditions that are associated with hemoptysis which include:
==Gross Pathology==
**[[Granulomatosis with polyangiitis]]
*On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
**[[Sarcoidosis]]
 
**[[Immunodeficiency]]
==Microscopic Pathology==
**Indoor ice hockey play<ref name="pmid8642238">{{cite journal |vauthors=Karlson-Stiber C, Höjer J, Sjöholm A, Bluhm G, Salmonson H |title=Nitrogen dioxide pneumonitis in ice hockey players |journal=J. Intern. Med. |volume=239 |issue=5 |pages=451–6 |date=May 1996 |pmid=8642238 |doi= |url=}}</ref><ref name="pmid22377844">{{cite journal |vauthors= |title=Exposure to nitrogen dioxide in an indoor ice arena - New Hampshire, 2011 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=61 |issue=8 |pages=139–42 |date=March 2012 |pmid=22377844 |doi= |url=}}</ref>
*On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Up-To-Date]]
[[Category:Emergency medicine]]

Latest revision as of 22:03, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

Lung has two main vascular systems that include pulmonary circulation and bronchial circulation. There are multiple anastomoses between pulmonary and bronchial arteries which create physiologic right to left shunts. Blood in the hemoptysis is mostly originated from the Lung. However, it could be from the gastrointestinal system as well. Primary origin of the blood comes from bronchial arteries. However, other sources of bleeding might be pulmonary vessels, aorta, intercostal, coronary, thoracic, and phrenic arteries. Hemoptysis is an important symptom that has different etiologies and pathogenesis mechanisms. Hemoptysis may happen following infarction and ischemia of pulmonary parenchyma as seen in pulmonary embolism, vasculitis, and infections. Another mechanism of hemoptysis is vascular engorgement with erosion as seen in bronchitis, bronchiectasis, and toxic exposure to cigarette and other irritants. In some cases underlying cause can not be identified and they are considered as idiopathic. However, they might present with massive hemoptysis. There are multiple conditions that are associated with hemoptysis which include granulomatosis with polyangiitis, sarcoidosis, immunodeficiency, and indoor ice hockey play.

Pathophysiology

Physiology

Illustration from Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013. By OpenStax College - Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013., CC BY 3.0,[1]
This slide shows the arterial and venous blood circulation of the pulmonary system. By Artwork by Holly Fischer - http://open.umich.edu/education/med/resources/second-look-series/materials - Respiratory Tract Slide 20, CC BY 3.0,[2]


{{#ev:youtube|K57qjYYjgIY}}

Pathogenesis

Associated Conditions

References

  1. ↑ "File:2119 Pulmonary Circuit.jpg - Wikimedia Commons".
  2. ↑ "File:Pulmonary Blood Circulation.png - Wikimedia Commons".
  3. ↑ "Hemoptysis - Clinical Methods - NCBI Bookshelf".
  4. ↑ Andersen, P. E. (2016). "Imaging and interventional radiological treatment of hemoptysis". Acta Radiologica. 47 (8): 780–792. doi:10.1080/02841850600827577. ISSN 0284-1851.
  5. ↑ Ittrich, H.; Klose, H.; Adam, G. (2014). "Radiologic Management of Haemoptysis: Diagnostic and Interventional Bronchial Arterial Embolisation". RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren. 187 (04): 248–259. doi:10.1055/s-0034-1385457. ISSN 1438-9029.
  6. ↑ 6.0 6.1 Noë, G.D.; Jaffé, S.M.; Molan, M.P. (2011). "CT and CT angiography in massive haemoptysis with emphasis on pre-embolization assessment". Clinical Radiology. 66 (9): 869–875. doi:10.1016/j.crad.2011.03.001. ISSN 0009-9260.
  7. ↑ Sakr, L.; Dutau, H. (2010). "Massive Hemoptysis: An Update on the Role of Bronchoscopy in Diagnosis and Management". Respiration. 80 (1): 38–58. doi:10.1159/000274492. ISSN 1423-0356.
  8. ↑ Gupta, Mudit; Srivastava, Deep Narayan; Seith, Ashu; Sharma, Sanjay; Thulkar, Sanjay; Gupta, Rashmi (2013). "Clinical Impact of Multidetector Row Computed Tomography Before Bronchial Artery Embolization in Patients With Hemoptysis: A Prospective Study". Canadian Association of Radiologists Journal. 64 (1): 61–73. doi:10.1016/j.carj.2011.08.002. ISSN 0846-5371.
  9. ↑ Shigemura, Norihisa; Wan, Innes Y.; Yu, Simon C.H.; Wong, Randolph H.; Hsin, Michael K.Y.; Thung, Hoi K.; Lee, Tak-Wai; Wan, Song; Underwood, Malcolm J.; Yim, Anthony P.C. (2009). "Multidisciplinary Management of Life-Threatening Massive Hemoptysis: A 10-Year Experience". The Annals of Thoracic Surgery. 87 (3): 849–853. doi:10.1016/j.athoracsur.2008.11.010. ISSN 0003-4975.
  10. ↑ Chun, Joo-Young; Morgan, Robert; Belli, Anna-Maria (2010). "Radiological Management of Hemoptysis: A Comprehensive Review of Diagnostic Imaging and Bronchial Arterial Embolization". CardioVascular and Interventional Radiology. 33 (2): 240–250. doi:10.1007/s00270-009-9788-z. ISSN 0174-1551.
  11. ↑ Tom, Lisa M.; Palevsky, Harold I.; Holsclaw, Douglas S.; Trerotola, Scott O.; Dagli, Mandeep; Mondschein, Jeffrey I.; Stavropoulos, S. William; Soulen, Michael C.; Clark, Timothy W.I. (2015). "Recurrent Bleeding, Survival, and Longitudinal Pulmonary Function following Bronchial Artery Embolization for Hemoptysis in a U.S. Adult Population". Journal of Vascular and Interventional Radiology. 26 (12): 1806–1813.e1. doi:10.1016/j.jvir.2015.08.019. ISSN 1051-0443.
  12. ↑ Zhao, Tian; Wang, Sini; Zheng, Lili; Jia, Zhongzhi; Yang, Yunjun; Wang, Weiping; Sun, Houzhang (2017). "The Value of 320-Row Multidetector CT Bronchial Arteriography in Recurrent Hemoptysis after Failed Transcatheter Arterial Embolization". Journal of Vascular and Interventional Radiology. 28 (4): 533–541.e1. doi:10.1016/j.jvir.2017.01.006. ISSN 1051-0443.
  13. ↑ Savale L, Parrot A, Khalil A, Antoine M, Théodore J, Carette MF, Mayaud C, Fartoukh M (June 2007). "Cryptogenic hemoptysis: from a benign to a life-threatening pathologic vascular condition". Am. J. Respir. Crit. Care Med. 175 (11): 1181–5. doi:10.1164/rccm.200609-1362OC. PMID 17332480.
  14. ↑ Herth F, Ernst A, Becker HD (November 2001). "Long-term outcome and lung cancer incidence in patients with hemoptysis of unknown origin". Chest. 120 (5): 1592–4. PMID 11713139.
  15. ↑ Karlson-Stiber C, Höjer J, Sjöholm A, Bluhm G, Salmonson H (May 1996). "Nitrogen dioxide pneumonitis in ice hockey players". J. Intern. Med. 239 (5): 451–6. PMID 8642238.
  16. ↑ "Exposure to nitrogen dioxide in an indoor ice arena - New Hampshire, 2011". MMWR Morb. Mortal. Wkly. Rep. 61 (8): 139–42. March 2012. PMID 22377844.
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