SHM Converge Scientific Abstract ePoster Gallery-A Therapeutic Challenge: Massive Bilateral Hemoptysis in Chronic Cystic Bronchiectasis With Concurrent Pulmonary Embolism

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This case describes a 70-year-old man with chronic bronchiectasis and prior smoke inhalation lung injury who presented with massive hemoptysis that was initially mistaken for hematemesis. He became unstable and required emergent intubation. Bronchoscopy showed extensive bilateral blood clots, and repeat bronchoscopy localized the bleeding to the left lower lobe. He was treated with nebulized tranexamic acid, local epinephrine, and bronchial artery embolization (BAE), which provided only temporary control. Angiography revealed hypertrophied, tortuous bronchial arteries with aneurysmal changes bilaterally.<br /><br />After extubation, he had recurrent massive hemoptysis requiring re-intubation and repeat BAE. Soon after, he developed worsening hypoxia and was found to have a submassive pulmonary embolism. Once bleeding appeared controlled, anticoagulation was started cautiously, but this triggered another episode of massive hemoptysis within 24 hours. Anticoagulation was then stopped and an inferior vena cava (IVC) filter was placed. Because of bilateral lung disease and repeated bleeding, he was not a surgical candidate for lobectomy and remained ventilator dependent.<br /><br />The report highlights the difficult balance between treating life-threatening thromboembolism and avoiding catastrophic rebleeding in patients with active or recently controlled hemoptysis. It emphasizes that current guidelines offer limited evidence for patients who need anticoagulation but have high bleeding risk. Management requires stabilization of bleeding, assessment of clot burden, consideration of alternatives such as temporary IVC filter placement, and close multidisciplinary collaboration among pulmonology, interventional radiology, critical care, surgery, and hospital medicine.

Asset Subtitle

Jharna Bai

Meta Tag

Author List Elie Hatem, Enda Byrnes, Ibtihal Safih, Jharna Bai, Juan F. Martinez Ortega, Muhammad Imran Gora, Mutaz Shaheen

Category Clinical Vignettes

Concept Massive Hemoptysis

Concept Pulmonary Embolism

Concept Airway Stabilization

Concept Bleeding Control

Concept Anticoagulation

Distinguished Non-Finalist

Presenter Organization NYCHHC/lincoln Hospital

Presenting Author Jharna Bai

Track Adult

Keywords

massive hemoptysis

bronchiectasis

bronchial artery embolization

pulmonary embolism

anticoagulation

IVC filter

bronchoscopy

rebleeding

respiratory failure

critical care

Massive Hemoptysis

Pulmonary Embolism

Airway Stabilization

Bleeding Control

Anticoagulation