Hemoptysis constitutes a common and urgent medical problem. Swift and effective management is of crucial importance, especially in severe, life-threatening cases. Because of bronchial artery or a branch of pulmonary artery erosion due to cavitary infiltration, bronchiectasis, fungus ball, broncholithiasis, or destroyed lung, the bleeding can lead to highly compromised gas exchange or sometimes can be a life-threatening situation. Chest computerized tomography and bronchoscopy remain the methods of choice for lateralization of the disease. Some patients can be treated successfully with endobronchial interventions. Bronchial artery embolization can be rewarding in some patients but the recurrence rate is higher in tuberculosis than other etiologies of hemoptysis. Surgical resection of the lung, mainly lobectomy, remains a life-saving procedure but it should be performed very selectively to avoid higher postoperative morbidity and mortality.

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CCAM is a congenital anamoly of lung, usually uncommon in adults. Presentation in adults is I.Case reportA 28 years-old unmarried, nonsmoker, Indian male, pursuing his Ph.D course in Soil and Agriculture, presented with the complaints of recurrent hemoptysis and chest pain for the last 2 yrs. Occasional fever with breathlessness, and anorexia was also present. There was no history of TB in family. On examination patient had PR=96/min, BP=112/74 mmHg, RR=26/min . His respiratory system revealed no tracheal shifting, breath sounds were decreased in the lower left lung fields with few crepitations. Rest of the systemic examination were within normal limits Biochemical tests showed the raised TLC. Sputum smear examination by gram and Ziel Nelson staining for AFB were negative. Viral markers (HbsAg, HIV. Anti-HCV) were non reactive. X-ray showed a thin walled cavity in the left lower lobe[ figure 1]. His recent CT Scan showed multiple thick walled cavitation in the left lower lobe with presence of mildly enhancing soft tissue density nodules and air crescent within the cavitation suggestive of fungal ball[figure2], with evidence of fibrobronchiectasis changes[figure3] in the left lower lobe. The patient underwent left lower lobectomy via posterolateral thoracotomy. Macroscopic examination of the specimen revealed a mass of 8x6x4 cm[figure4], on sectioning the mass multiple cysts were noted. The largest cyst was of 2cmx2cm in size and multiple small cysts were of 3mm-5mm in size. Microscopic examination revealed large dilated bronchi lined by normal columnar ciliated epithelium and and were filled with degenerated material. The number of alveoli were very few. The stroma between the bronchiole was infiltrated by chronic inflammatory cells. A significant discovery of aspergillus hyphae was made in the mass and highlighted by Grocott's methamine silver stain. Both histological and radiological findings were consistent with Type 2 CCAM .

Eventration of the diaphragm (ED) is