Hospitalist University of Iowa hospital and clinics, United States
Introduction: Bronchial Dieulafoy lesions are quite rare, with fewer than 100 cases reported worldwide to date. We present a rare case of recurrent hemoptysis secondary to recurring Dieulafoy lesions in the lungs. Notably, in our case, the Dieulafoy lesion occurred in the same lobe but involved a different vessel than the one previously treated.
Description: A patient with a history of recurrent hemoptysis secondary to a Dieulafoy lesion, status post embolization, presented to the hospital with complaints of six episodes of bright red hemoptysis, which subsided after discontinuing aspirin. Later, the patient had a persistent cough and intermittent sputum with old blood products. He denied fever, chills, headaches, nausea, vomiting, diarrhea, or urinary issues. Labs revealed hemoglobin 14.4mg/dl and hematocrit 45%. A CT angiogram of the chest revealed subtle ground-glass changes in the anterior right upper, right middle, right lower, lingula, and left lower lobes, endobronchial filling defects within the right lower lobe, and hypertrophy of lower lobe vasculature bilaterally. Bronchoscopy revealed a pulsatile submucosal vascular lesion in RB8 with extensive thrombus occluding the distal right main bronchus. The case was discussed with interventional radiology (IR), and a successful IR-guided right bronchial artery embolization was performed with 300–500-micron embospheres.
Discussion: Bronchial Dieulafoy lesions are a rare but serious cause of hemoptysis. They are described as a dilated and tortuous artery that protrudes from the submucosa, originating from either the pulmonary or bronchial artery. These lesions are frequently underdiagnosed. Risk factors for bleeding include heavy smoking, aging, iatrogenic injury during bronchoscopy, history of bronchiectasis, tuberculosis, and frequent pneumonia. The most common clinical feature is recurrent hemoptysis. Diagnosis is made by angiography, with bronchoscopy/endobronchial ultrasound being particularly useful for proximal lesions. The primary treatment modality is arterial embolization. In cases of failed embolization, surgical resection may be required. Additional treatment options include cauterization, cryotherapy, or argon plasma coagulation.
