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

Sunday, June 1, 2025 at 8:00AM
Rick Robbins, M.D. in CT scan, Staphylococcus aureus, bronchoscopy, chest x-ray, congenital unilateral pulmonary venous atresia, hemoptysis, pathophysiology, pneumonia, pulmonary atresia, pulmonary venous atresia

Robert A. Raschke MD¹

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)

1. It can be defined by as little as 150ml (about a half cup) of hemoptysis per day
2. Urgent bronchoscopy is indicated to remove obstructive blood clots, and to localize and treat bleeding.
3. Positioning the patient with the bleeding side down may be indicated.
4. Massive hemoptysis is dependent on bronchial circulation in about 90% of cases, therefore bronchial artery embolization is often effective.
5. All the above

Article originally appeared on Southwest Journal of Pulmonary, Critical Care and Sleep (https://www.swjpcc.com/).