June 2025 Pulmonary/Critical Care Case of the Month: Hemoptysis from a Very Unusual Cause

Arooj Kayani MD1
Michael B. Gotway MD2
1Critical Care Medicine, Scottsdale Osborn Medical Center, Scottsdale, AZ USA
2Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ USA
A 23-year-old man presented to our hospital emergency room (ER) with one week of non-productive cough and mild pleuritic chest pain followed by 24 hours of hemoptysis, producing about a teaspoon of bright red blood every 15 mins. His blood pressure was 146/83, HR 103, RR 16, temperature 98.6 F. and room air oxygen saturation was 96%. He was in no respiratory distress and his physical examination was unremarkable.
Initial laboratory studies including a white blood cell count, serum electrolytes, glucose, and renal function, liver indices, a coagulation profile, a procalcitonin level, and a urinalysis were all within normal limits. A PCR for SARS-CoV-2, influenza and RSV was negative.
Which of the following are true regarding massive hemoptysis? (Click on the correct answer to be directed to the second of five pages)
- It can be defined by as little as 150ml (about a half cup) of hemoptysis per day
- Urgent bronchoscopy is indicated to remove obstructive blood clots, and to localize and treat bleeding.
- Positioning the patient with the bleeding side down may be indicated.
- Massive hemoptysis is dependent on bronchial circulation in about 90% of cases, therefore bronchial artery embolization is often effective.
- All the above
Reader Comments