A 31-Year-Old Female With Postcoital Hemoptysis

Hemoptysis is a common presenting symptom in the clinical setting. The most frequent causes of non-life-threatening hemoptysis, which usually originates from the pulmonary arterial circulation, include pulmonary pathologies such as infections, inflammatory airway diseases, and bronchial neoplasms. Hemoptysis occurring only after sexual intercourse, however, is a rare phenomenon. Most of the reported cases have resulted from an underlying cardiac pathology that is predisposed to acute cardiovascular decompensation, a sharp increase in pulmonary capillary pressures, and pulmonary capillary rupture during intercourse. We present the case of a 31-year-old African-American hypertensive female who presented with a six-month history of recurrent post-coital hemoptysis. Other strenuous physical activities did not result in similar episodes. Her workup ruled out the more common etiologies of hemoptysis. Computed tomography of the chest revealed bilateral centrilobular ground-glass opacities and transthoracic and transesophageal echocardiograms revealed moderate to severe mitral regurgitation with a normal left ventricular ejection fraction of 60-65%. After management with lisinopril, she reported no new episodes of post-coital hemoptysis, and a repeat chest CT showed complete resolution of the ground glass opacities bilaterally. This underscores the importance of performing a thorough cardiovascular workup in patients presenting with only post-coital hemoptysis.