Hemoptysis from an emphysematous bulla developing after open-heart surgery: report of a case

We present herein the case of a 62-year-old woman with an emphysematous bulla who developed intractable hemoptysis 16 days after undergoing mitral and aortic valve replacement with tricuspid annuloplasty. A bronchoscopic examination with balloon occlusion of the bronchial lumen revealed that the blood source was the right middle lobe bronchus. A computed tomographic (CT) scan of the chest subsequently demonstrated a blood-filled emphysematous bulla in the right middle lobe. A right middle lobectomy was performed and the bulla was observed to be swollen with clotted blood. The respiratory tract bleeding stopped immediately after the lobectomy. Pathohistological examinations suggested that disruption of the pulmonary vessels in the wall of the bulla had caused the respiratory tract bleeding.