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5. No change
The chest x-ray shows extensive postoperative changes in the right upper lung with a right upper lobectomy. There is bilateral perihilar scarring and volume loss compatible with chronic sarcoidosis. Bullae or cavitary changes are present in both upper lungs which are stable. Overall no new or progressive abnormality is seen.
A CT of the chest was performed (Figure 3).
Figure 3. Panels A-D: Selected static lung windows from the thoracic CT scan. Lower panel: movie of selected panels from the thoracic CT scan.
The CT scan was interpreted as showing new tiny nodules seen within the left lower lobe, anterior basilar segment, and lingula with patchy ground glass opacities. There was also new soft tissue opacity within the left upper lobe cavity. Otherwise, there were no changes from previous CT scans.
A decision was made in an attempt to localize the bleeding by fiberoptic bronchoscopy. The bronchoscopy showed bright red blood in the trachea and both mainstem airways (Figure 4).
Figure 4. View of trachea during fiberoptic bronchoscopy.
The patient began coughing during washings followed by hemoptysis of about 200 ml of fresh blood occurred.
What should be done at this time? (click on correct answer to move to next panel)