Pulmonary embolism after treatment for massive hemoptysis: a therapeutic dilemma

Massive hemoptysis is a life-threatening condition requiring prompt hemostatic intervention. After hemostatic treatment, thromboembolic complications may pose a dilemma when anticoagulation is necessary but carries a risk of rebleeding. A 72-year-old man with chronic obstructive pulmonary disease was admitted for recurrent hemoptysis. Bronchial angiography revealed a markedly dilated right bronchial artery with intrapulmonary shunting. Because of massive hemoptysis and respiratory failure, emergency bronchial artery embolization was performed, followed by right middle lobectomy with corresponding bronchial artery ligation to reduce rebleeding risk. After surgery, persistent bleeding from segmental bronchi was controlled by endobronchial Watanabe spigot. Pulmonary embolism was subsequently detected by contrast-enhanced computed tomography. A second bronchial angiography confirmed complete hemostasis before anticoagulation. Heparin infusion was initiated, followed by a switch to edoxaban. He recovered without recurrent hemoptysis. This case highlights the challenge of balancing hemostasis and anticoagulation when pulmonary embolism develops after stepwise multimodal hemostatic therapy.