Correct!
4. 1 and 3
The patient has at least 2 reasons for hemoptysis-a connective tissue disease and mitral valve disease. Usually, hemoptysis indicates a bronchial process such as bronchitis or lung cancer. However, there is no clinical signs to suggest either of these two common processes. It was felt that a transesophageal echocardiogram (TEE) and bronchoscopy would likely both be necessary and both procedures were simultaneously performed
The TEE showed a left ventricular ejection fraction of (LVEF) 74% with a mitral valve diastolic mean Doppler gradient of 23 mm Hg and a right ventricular systolic pressure (RVSP) 57 mm Hg.
Bronchoscopy showed blood within the airways. After washing to remove the blood, the bronchial mucosa was hyperemic with dilated submucosal veins (Figure 3).
Figure 3. Representative bronchoscopic images showing bronchial hyperemia and mucosal vein dilation.
Bronchoalveolar lavage resulted in a bloody return which did not clear.
What is the most likely cause of her hemoptysis? (Click on the correct answer to proceed to the fourth and final page)