Massive Hemoptysis in a Patient With Eisenmenger Syndrome, Polysplenia and Transverse Liver

Hemoptysis is defined as blood-streaked sputum from the lower parts of the respiratory tract. Hemoptysis, even in small amounts, is a frightening and alarm sign for possible underlying conditions such as infections, pulmonary diseases, neoplastic conditions, cardiovascular alterations, vasculitis, traumatic events, hematological derangements, and iatrogenic or drug-induced events. The initial step in the evaluation of hemoptysis is to determine the source of bleeding. Herein, we report an unusual case of massive hemoptysis in a young patient with polysplenia and Pulmonary Artery Hypertension (PAH) in the setting of Eisenmenger syndrome. Chest radiography was suggestive of multiple lung opacities bilaterally. Chest Computed Tomography (CT) revealed a non-heterogeneous mass-like lesion measuring 4 × 5.2 × 5.6 cm in the superior segment of the inferior lobe of the left lung, concerning for an accessory spleen. The patient underwent Video bronchoscopy, which showed tracheomalacia and active bleeding in the left main bronchus. The bleeding was controlled by the Argon Plasma Coagulation (APC) technique. Bronchoalveolar lavage (BAL) was negative for acid-fast bacilli on staining and on culture. After stabilization, the patient was discharged home on medical management for PAH. On two-week follow-up, imaging revealed resolution of the pulmonary mass-like lesion. Our report highlights the importance of bronchoscopy in determining the bleeding source in patients with hemoptysis and managing it via the APC technique.