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Massive Pulmonary Hemorrhage from Bronchial Varix.
Michael Agustin1, Scott Shay1, Jose Gonzalez1
1Guam Regional Medical City Intensive Care Unit, 133 Route 3, 96929 Dededo, Guam, USA.
Case Reports in Pulmonology
|April 22, 2020
Summary
A rare bronchial varix caused massive hemoptysis. Initial management included tranexamic acid, epinephrine, and embolization, followed by prone ventilation and clot removal, leading to improved oxygenation before surgery.
Area of Science:
- Pulmonology
- Vascular Medicine
Background:
- Bronchial varix is a rare pulmonary condition.
- It can cause life-threatening hemorrhage.
- Diagnosis is challenging due to subtle radiographic and bronchoscopic findings.
Observation:
- A case of massive hemoptysis from a bleeding bronchial varix is presented.
- Initial management in Guam involved tranexamic acid and epinephrine due to limited endobronchial therapy options.
- Selective bronchial artery embolization was performed.
Findings:
- Prone positioning and ventilation were initiated for severe hypoxia caused by airway blood clots.
- Intermittent bronchoscopic extraction of clots in the prone position improved lung ventilation and oxygenation.
- The patient ultimately underwent successful bronchial sleeve resection.
Implications:
- This case highlights a multidisciplinary approach to managing severe hemoptysis from bronchial varix.
- It demonstrates the utility of conservative measures and prone ventilation when advanced therapies are unavailable.
- Definitive surgical management remains crucial for long-term resolution.
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