Cast of the left bronchial tree

Area of Science:

• Pulmonology
• Interventional Radiology

Background:

• Sarcoidosis is a multisystem inflammatory disease that can affect the lungs.
• Chronic steroid use is common in managing sarcoidosis.
• Pulmonary manifestations of sarcoidosis can include cystic and fibrotic changes.

Purpose of the Study:

• To describe a rare case of massive hemoptysis in a patient with advanced sarcoidosis.
• To highlight the diagnostic and therapeutic challenges in managing severe bleeding from the airways.

Main Methods:

• Computed tomography (CT) imaging to assess lung involvement.
• Bronchoscopy for localization and intervention.
• Bronchial artery angiography and embolization.
• Cryoprobe extraction of bronchial cast.

Main Results:

• Stage IV sarcoidosis with diffuse cystic and fibrotic changes was identified.
• Massive hemoptysis occurred post-bronchoscopy, leading to cardiopulmonary arrest.
• Bronchial artery embolization was performed without immediate cessation of bleeding.
• A large bronchial cast was removed from the left main bronchus during a second episode of hemoptysis.

Conclusions:

• Massive hemoptysis can be a life-threatening complication in advanced sarcoidosis.
• Bronchial casts can form and obstruct the airways, necessitating urgent removal.
• Management requires a multidisciplinary approach involving pulmonologists and interventional radiologists.