Unusual case of hemoptysis 13 years after bilobectomy

We describe a 68-year-old man with recurrent episodes of hemoptysis. The patient had undergone right upper and middle lobectomies for a benign cystic lesion 13 years ago and coronary artery bypass grafting for ischemic heart disease immediately before the onset of hemoptysis. Diagnostic work-up revealed that pulmonary arterial flow to the remaining right lower lobe had been inadvertently compromised by prior ligation of the right main pulmonary artery during the time of his bilobectomy, with the development of a robust collateral blood supply derived from bronchial and intercostals arteries. Successful treatment required percutaneous embolization of the dominant bronchial collaterals, followed by completion pneumonectomy.