Massive hemoptysis, the etiology is aorto-bronchial fistula

Abstract

A 41-year-old man presented with massive hemoptysis. On physical examination, auscultation of the lung reveals inspiratory crackles, predominantly located in the lower posterior lung zones and auscultation of the heart reveals 2/6 systolic souffle in all of the cardiac zones. During the observation in emergency room, the patient's hemoglobin values decreased from 15.5 mg/dL to 11.7 mg/dL. Because of this reason, erytrocyte suspension transfusion had been processed. Bilateral diffuse infiltration could be seen in postero-anterior chest X-ray. In the computed tomography (CT) of thorax, there was bilateral parenchymal ground glass opacities and consolidations (Figure 1). During bronchoscopy, active bleeding from bilateral bronchial system was observed. Since intraalveolar hemorrhage was considered at the patient, etiology oriented examinations were evaluated. Patient was extubated after the hemopthysis had been controlled and then, he was transferred to the chest diseases clinique from the intensive care unit. Both in bronchoscopic samples and sputum samples of the patient, there was no acid resistant bacterium in direct microbiological examination and cultures for acid resistant bacterium were negative. In the evaluation of the patient in terms of vasculitic syndromes; anti-nuclear antibody, anti-neutrophilic cytoplasmic antibody and ENA panel were detected and they were all negative. In the medical consultation made with cardiothoracic surgery, there was no additional suggestion. In the control bronchoscopy for hemorrhage, only a former bleeding focal point on the left main bronchi has been observed. During bronchoscopy; bronchial lavage, bronchoalveolar lavage (from the right middle lobe bronchi) and transbronchial biopsy samples were obtained. However, those samples weren't useful for a specific diagnosis. Three months later, in the control CT of thorax of the case, ground glass 295Massive hemoptysis, the etiology is aorto-bronchial fistula