28321071 Visualization

An 82 Age - year Age - old Age woman Sex was transferred Clinical_event to our hospital Nonbiological_location because of dyspnea Sign_symptom and massive Severity hemoptysis Sign_symptom .
The patient had a history of bronchial History asthma History that was well-controlled with bronchodilator History medications History .
She had no History history History of History tuberculosis, History nontuberculous History mycobacterial History infection, History or History smoking History .
The physical Diagnostic_procedure examination Diagnostic_procedure revealed diffuse Detailed_description bilateral Detailed_description crackles Sign_symptom .
She suffered from severe Severity hypoxemia Sign_symptom ( pH Diagnostic_procedure 7.362 Lab_value , PCO2 Diagnostic_procedure 35.1 Lab_value mmHg Lab_value , PO2 Diagnostic_procedure 61.0 Lab_value mmHg Lab_value , HCO3- 20.1 Lab_value mmHg Lab_value , BE Diagnostic_procedure -5.5 mmHg Lab_value , SpO2 Diagnostic_procedure 90.5% Lab_value , under Lab_value 10 Lab_value L Lab_value O2/min Lab_value , reservoir Detailed_description mask Detailed_description ).
After the tracheal Biological_structure intubation Therapeutic_procedure , 100 Volume mL Volume of bright Color - red Color blood Biological_structure was aspirated Sign_symptom .
A chest Biological_structure radiograph Diagnostic_procedure showed bilateral Detailed_description infiltrates Sign_symptom (Fig.1).
A chest Biological_structure CT Diagnostic_procedure further demonstrated multiple Detailed_description consolidations Sign_symptom and ground Texture glass Texture opacity Sign_symptom and focal Detailed_description bronchiectasis Disease_disorder in right Biological_structure segment Biological_structure 4 Biological_structure ( S4 Biological_structure ) (Fig.2).
There were no space Detailed_description - occupying Detailed_description lesions Sign_symptom .
Four Date days Date after Date admission, her respiratory Diagnostic_procedure condition Diagnostic_procedure was improved Lab_value .
Since there was no active Detailed_description hemorrhaging Sign_symptom from the tracheal Therapeutic_procedure tube Therapeutic_procedure , she was then extubated Therapeutic_procedure .
After that, only a small Severity amount Severity of bloody Detailed_description sputum Sign_symptom was coughed up.
To determine the origin of bleeding, she underwent contrast Detailed_description - enhanced Detailed_description CT Diagnostic_procedure , which showed bronchiectasis Disease_disorder in right Biological_structure S4 Biological_structure and regression of the infiltration Sign_symptom .
CTA Diagnostic_procedure revealed an abnormal Detailed_description vascular Biological_structure anastomosis Disease_disorder between the right Biological_structure inferior Biological_structure phrenic Biological_structure artery Biological_structure and right Biological_structure pulmonary Biological_structure artery Biological_structure beside the focal Detailed_description bronchiectasis Disease_disorder at the right Biological_structure middle Biological_structure lobe Biological_structure (Fig.3), which led us to suspect it as the possible source of the massive Severity hemoptysis Sign_symptom .
We therefore performed embolization Therapeutic_procedure by superselecting Therapeutic_procedure the right Biological_structure inferior Biological_structure phrenic Biological_structure artery Biological_structure with a 2.2 Detailed_description - Fr. Detailed_description microcatheter Detailed_description (Fig.4).
An angiogram Diagnostic_procedure of the right Biological_structure bronchial Biological_structure artery Biological_structure showed no obvious active Detailed_description bleeding Sign_symptom .
Three Date weeks Date after Date the embolization, she was successfully discharged Clinical_event and has been free from recurrent Detailed_description hemoptysis Sign_symptom for three Duration years Duration .