Active pulmonary hemorrhage localized by selective pulmonary angiography

Massive hemoptysis in a young woman with negative chest film findings is presented. By using selective pulmonary artery angiography during active pulmonary bleeding, the following findings were demonstrated: (1) intraparenchymal hemorrhage, (2) clearing of blood from the lung and bronchial tree by coughing, (3) early filling of the inferior pulmonary vein. Following lobectomy, specimen angiography suggests the presence of a small arteriovenous fistula. This experience demonstrates that selective pulmonary arteriography may be a useful adjunct in the management of selected patients with massive hemoptysis of obscure etiology.