Correct!
3. Mitral stenosis
The cardiac ultrasound showed a markedly elevated mitral valve gradient of 23 mm Hg with an elevated RVSP of 57 mm Hg. A gradient of >10 mm Hg is considered severe. Furthermore, the ultrasound showed a stationary lateral mitral valve leaflet secondary to a thrombus. This resulted in functional mitral stenosis.
Patients with chronically elevated left atrial pressures from mitral stenosis have engorged pulmonary veins (1). The pulmonary veins transmit the excess pressure into the bronchial venous plexus which transmit the pressures to the bronchial veins. This results in the intensely hyperemic mucosa with dilatation of submucosal veins as seen in our patient.
Hemoptysis, regardless of the amount, is usually considered an indication for bronchoscopy, especially when it is unexplained and/or recurrent (2). Massive hemoptysis has no standard definition but occurs when the amount or the rate of bleeding becomes potentially life-threatening. Patients with an intact cough reflex usually are able to clear their airways, but when bleeding is >500 ml in 24 hours or >100 ml in an hour, bleeding may overwhelm the patient’s ability to expectorate the blood (3). Urgent bronchoscopy should be performed in unstable patients. It can be used to facilitate the introduction of balloon-tip catheters into the bleeding bronchus for tamponade of the hemorrhagic artery, protecting the contralateral lung or nonbleeding bronchi from blood aspiration. Endobronchial tamponade should only be used as a temporary measure until a more specific treatment is instituted. In stable patient computed tomography should be ordered before any bronchoscopic exploration.
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