Active pulmonary hemorrhage localized by selective pulmonary angiography

Area of Science:

• Pulmonology
• Radiology
• Vascular Surgery

Background:

• Massive hemoptysis presents a diagnostic challenge, particularly when initial chest imaging is unremarkable.
• Identifying the precise source of pulmonary bleeding is critical for effective patient management.

Observation:

• A young woman with massive hemoptysis and normal chest film findings underwent selective pulmonary artery angiography during active bleeding.
• Angiography revealed intraparenchymal hemorrhage, clearance of blood via coughing, and early filling of the inferior pulmonary vein.

Findings:

• Post-lobectomy specimen angiography suggested a small arteriovenous fistula as the underlying cause.
• Selective pulmonary arteriography successfully identified the bleeding source in a case of obscure massive hemoptysis.

Implications:

• Selective pulmonary arteriography is a valuable tool for diagnosing massive hemoptysis of unknown origin.
• This diagnostic approach can guide surgical or interventional management, improving outcomes for patients with severe pulmonary bleeding.