Beyond the Bronchi: Uncovering a Rare Mid-esophageal Dieulafoy Lesion in Non-massive Hemoptysis

Hemoptysis has an annual incidence in the United States (US) of 0.1-0.2% in the outpatient and inpatient clinical settings, respectively. True hemoptysis is described in medical literature as the expectoration of blood-tinged sputum originating from the lower respiratory tract. The severity of hemoptysis ranges from non-massive to massive. By contrast, pseudohemoptysis is the expectoration of blood-tinged sputum originating from the upper gastrointestinal (GI) or nasopharyngeal tract. We report the case of a 91-year-old woman undergoing stepwise evaluation of non-massive, recurrent hemoptysis of three-month duration with chest pain. Extensive radiological imaging, including computed tomography angiography (CTA) of the thoracic, head, and neck, did not reveal active extravasation of vascular vessels. Fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) demonstrated mild erythema of the right upper lobe (RUL) without an obvious source of bleeding. Broader workup of hemoptysis with gastroenterology consultation for endoscopic ultrasound (EUS) and esophagogastroduodenoscopy (EGD) revealed a rare mid-esophageal Dieulafoy lesion with stigmata of recent bleeding. The defect is then repaired with improvement in clinical symptoms of hemoptysis. This case highlights a rare instance of an esophageal Dieulafoy lesion masquerading as hemoptysis.