Tuberculosis is a global disease with a high prevalence rate in the Philippines. Frank hemoptysis often occurs later in the disease and is usually not massive since the availability of anti-Koch’s treatment. However, Rasmussen’s aneurysm, a pulmonary vascular complication secondary to tuberculosis from the weakening of the pulmonary arterial wall adjacent or within a tuberculous cavity, can be an uncommon cause of massive and potentially fatal hemoptysis.

A 35-year-old male patient presented with episodes of hemoptysis while being treated for pulmonary tuberculosis for two weeks. An episode of massive hemoptysis of ~400ml prompted his admission. Chest tomography with contrast showed bronchiectatic changes, cavitary formation, and an aneurysmal dilatation of the anterior segmental artery of the left upper lobe. He was diagnosed with Rasmussen’s aneurysm. A multidisciplinary team consisting of pulmonologists, interventional radiologists and thoracic surgeons planned for a surgical intervention as coil embolization was deemed to be difficult due to the wide neck character of the aneurysm. On re-admission after patient optimization, repeat chest tomography showed interval regression of pulmonary cavity with thrombosis of the previously identified Rasmussen’s aneurysm. Patient completed his 6-month antitubercular treatment with no further episodes of hemoptysis.

In patients with tuberculosis, hemoptysis results from involvement of the parenchyma, bronchiectasis, or erosion of residual cavities. Hemoptysis from the rupture of a dilated vessel such as Rasmussen’s aneurysm is a rare cause. Chest tomography with contrast is the imaging modality of choice as it demonstrates the focal pulmonary artery dilatation. Embolization or surgical lobectomy are typically utilized to control the bleeding. However, treatment with anti-tuberculous regimen may result already in regression and eventual thrombosis of the aneurysm. Watchful monitoring is imperative as massive hemoptysis may recur; radiologists and surgeons must be available at any time in case intervention is required.

Tuberculosis is a global disease with a high prevalence rate in the Philippines. Frank hemoptysis often occurs later in the disease and is usually not massive since the availability of anti-Koch’s treatment. However, Rasmussen’s aneurysm, a pulmonary vascular complication secondary to tuberculosis from the weakening of the pulmonary arterial wall adjacent or within a tuberculous cavity, can be an uncommon cause of massive and potentially fatal hemoptysis.

A 35-year-old male patient presented with episodes of hemoptysis while being treated for pulmonary tuberculosis for two weeks. An episode of massive hemoptysis of ~400ml prompted his admission. Chest tomography with contrast showed bronchiectatic changes, cavitary formation, and an aneurysmal dilatation of the anterior segmental artery of the left upper lobe. He was diagnosed with Rasmussen’s aneurysm. A multidisciplinary team consisting of pulmonologists, interventional radiologists and thoracic surgeons planned for a surgical intervention as coil embolization was deemed to be difficult due to the wide neck character of the aneurysm. On re-admission after patient optimization, repeat chest tomography showed interval regression of pulmonary cavity with thrombosis of the previously identified Rasmussen’s aneurysm. Patient completed his 6-month antitubercular treatment with no further episodes of hemoptysis.

In patients with tuberculosis, hemoptysis results from involvement of the parenchyma, bronchiectasis, or erosion of residual cavities. Hemoptysis from the rupture of a dilated vessel such as Rasmussen’s aneurysm is a rare cause. Chest tomography with contrast is the imaging modality of choice as it demonstrates the focal pulmonary artery dilatation. Embolization or surgical lobectomy are typically utilized to control the bleeding. However, treatment with anti-tuberculous regimen may result already in regression and eventual thrombosis of the aneurysm. Watchful monitoring is imperative as massive hemoptysis may recur; radiologists and surgeons must be available at any time in case intervention is required.

Hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber syndrome, is a rare autosomal dominant hereditary disorder characterized by multisystem vascular malformations, including mucocutaneous telangiectasia and arteriovenous malformations. This paper reports a case of a male patient with HHT admitted to the Second Xiangya Hospital of Central South University who presented with hemoptysis, an uncommon manifestation in HHT. Imaging revealed bilateral bronchial artery dilatation and tortuosity, as well as bilateral pulmonary artery enlargement. Whole-exome sequencing for monogenic disorders ultimately identified an ACVRL1 gene mutation, confirming a diagnosis of HHT type 2. Diagnosis of HHT is primarily based on clinical manifestations, imaging findings, and family history, while genetic testing facilitates definitive diagnosis and subtyping. Anti-angiogenic therapy has proven to be an effective and safe treatment approach for controlling hemoptysis, epistaxis, and gastrointestinal bleeding in HHT patients. This case highlights the importance of early genetic screening in suspected cases to enable timely etiological clarification and intervention.
Humans ; Telangiectasia, Hereditary Hemorrhagic/diagnosis* ; Hemoptysis/etiology* ; Male ; Activin Receptors, Type II/genetics* ; Mutation

Bronchial artery embolization (BAE) plays a crucial role in the treatment of hemoptysis, and its efficacy and safety have been proved. Although BAE is widely used in the treatment of hemoptysis, there is currently no standardized procedure for BAE, and there are significant differences between institutions and operators. To achieve standardization and normalization of the BAE in the treatment of hemoptysis, the Chinese College of Interventionalists (CCI) proposed this expert consensus, which is based on existing evidence and combined with clinical practice in China. This expert consensus is about patient selection, preoperative preparation, intraoperative procedures, postoperative management, efficacy evaluation and follow-up. After multiple rounds of discussion, this "expert consensus on the bronchial artery embolization in the treatment of hemoptysis" was proposed.
Humans ; Embolization, Therapeutic/methods* ; Hemoptysis/therapy* ; Bronchial Arteries ; Consensus

Hemoptysis is a serious medical emergency associated with high mortality rates. Notably, it poses significant therapeutic challenges owing to the complexities in rapidly identifying the bleeding site and underlying cause. In severe cases, it can lead to death by asphyxia, thus necessitating prompt intervention. Bronchoscopy-guided endobronchial balloon occlusion (EBBO) is a vital procedure for blocking the bleeding bronchus, allowing time for subsequent embolization of the responsible vessel and definitive treatment. While traditional techniques for EBBO are intricate and demanding, recent advancements in balloon technology, along with procedural refinements, have simplified the process, reduced operation times, and enhanced medical staff proficiency. Nevertheless, a lack of standardized protocols and technical guidelines has hindered the widespread adoption of this technique in China. Accordingly, the Internal Medicine of Chinese Medical Association convened a group of experts to develop the "Expert consensus on endobronchial balloon occlusion in the treatment of hemoptysis (2025 edition)" to standardize this procedure. This consensus, grounded in evidence-based medicine and clinical practice both domestically and internationally, covers seven essential elements: treatment strategies, equipment, indications and contraindications, preoperative preparation, technical procedures and specifications, integration with other therapeutic techniques, efficacy assessment, and follow-up. By offering comprehensive guidance, the consensus aims to standardize and promote the use of EBBO for hemoptysis management in China.
Humans ; Hemoptysis/therapy* ; Balloon Occlusion/methods* ; Bronchoscopy ; Consensus ; Evidence-Based Medicine

Humans ; Hemoptysis ; Myocardial Infarction/therapy* ; Percutaneous Coronary Intervention/adverse effects* ; Treatment Outcome ; ST Elevation Myocardial Infarction

Objective: To summarize the clinical characteristics of bronchial-pulmonary artery fistula and evaluate the effect of interventional closure of bronchial-pulmonary artery fistula. Methods: A retrospective case study was conducted. Fifteen children with hemoptysis who were diagnosed with bronchial-pulmonary artery fistula in Beijing Children's Hospital, Capital Medical University from January 2018 to March 2022 were selected. Their clinical symptoms and chest-enhanced CT findings were recorded. The children who failed to improve after anti-infection and hemostasis treatment were treated with transcatheter embolization through microparticles under digital subtraction angiography (DSA). The efficacy and post-operation recurrence were evaluated. Results: There were 15 children, including 9 males and 6 females, aged 9.8 (3.7, 12.1) years, weighing 35 (16, 55) kg. There was hemoptysis of varying degrees before surgery. Only 2 children had decreased hemoglobin. Chest enhanced CT showed that their bronchial arteries were thickened and tortuous, including 11 cases of single vessel disease and 4 cases of multivessel disease; 11 children had varying degrees of pneumonia and 4 children had atelectasis. Except for one case effectively treated with medical therapy, the remaining 14 cases were all treated with transcatheter interventional closure with embolic microparticles, among whom 12 had their fistula completely blocked with a single operation and the other 2 children underwent multiple operations because of too many fistulas. One child had extensive bronchial-pulmonary artery fistula which failed to be blocked completely even after multiple operations. Among the remaining 13 children, only 2 patients whose fistula was considered to be completely closed had recurrence presenting with hemoptysis at 3 months and 2 years after the operation, and no hemoptysis was found after the second closure. All children were discharged without chest pain, spinal cord paraplegia, or other serious complications. Fourteen children were followed up for 1.4 (0.9,2.9) years, among whom one still has intermittent mild hemoptysis due to incomplete closure and the rest had a satisfactory outcome. Conclusions: Hemoptysis is the first symptom of bronchial-pulmonary artery fistula. For children with failed medical treatment, transcatheter closure with an embolic pellet is effective, safe and feasible, with a low recurrence rate.
Child ; Female ; Male ; Humans ; Pulmonary Artery ; Retrospective Studies ; Chest Pain ; Hemoptysis/therapy* ; Hospitals, Pediatric

Chronic pulmonary aspergillosis (CPA) is a rare disease. It is usually diagnosed in immunocompromised patients with other chronic respiratory disorders. Diagnosis can be challenging due to non-specific symptoms. It is based on clinical, radiological, and microbiological criteria and excludes other causes of the symptoms. The outcomes of antifungal treatment may be unpredictable as optimal treatment duration has not yet been standardized. This is the case of a 74-year-old male who presented via teleconsultation with hemoptysis. GeneXpert for pulmonary tuberculosis was negative. Chest radiograph showed a cavitary lesion with an aspergilloma within. This led to a longstanding treatment effort with voriconazole, as he was a poor candidate for surgical resection due to the risk of post-operative complications. Three months into the treatment, the patient unexpectedly suffered from a severe episode of dyspnea, culminating in cardiac arrest. While the patient has been resuscitated with no residuals, it is only one of the many steps on his road to recovery and his second lease on life, this time coming to terms with his own preferences and values regarding his medical care. The patient showed clinical improvement and the promise of a cure in his fifth month of treatment. Learning points include the role of family physicians in a patient’s well-being even in specialized cases, the value of individualized care and the application of technology in hybrid consultation and monitoring.
Aspergillosis ; hemoptysis ; voriconazole

A boy, aged 11 years, was admitted due to intermittent fever for 15 days, cough for 10 days, and "hemoptysis" for 7 days. The boy had fever and cough with left neck pain 15 days ago, and antibiotic treatment was effective. During the course of disease, the boy developed massive "hemoptysis" which caused shock. Fiberoptic bronchoscopy revealed a left pyriform sinus fistula with continuous bleeding. In combination with neck and vascular imaging examination results, the boy was diagnosed with internal jugular vein injury and thrombosis due to congenital pyriform sinus fistula infection and neck abscess. The boy was improved after treatment with temperature-controlled radiofrequency ablation for the closure of pyriform sinus fistula, and no recurrence was observed during the follow-up for one year and six months. No reports of massive hemorrhage and shock due to pyriform sinus fistula infection were found in the searched literature, and this article summarizes the clinical features, diagnosis, and treatment of this boy, so as to provide a reference for the early diagnosis of such disease and the prevention and treatment of its complications.
Abscess/surgery* ; Cough ; Fever/complications* ; Fistula/surgery* ; Hemoptysis/complications* ; Humans ; Male ; Neck ; Shock

OBJECTIVE: To analyze the complications of percutaneous transthoracic needle biopsy using CT-based imaging modalities for needle guidance in comparison with fluoroscopy in a large retrospective cohort. MATERIALS AND METHODS: This study was approved by multiple Institutional Review Boards and the requirement for informed consent was waived. We retrospectively included 10568 biopsies from eight referral hospitals from 2010 through 2014. In univariate and multivariate logistic analyses, 3 CT-based guidance modalities (CT, CT fluoroscopy, and cone-beam CT) were compared with fluoroscopy in terms of the risk of pneumothorax, pneumothorax requiring chest tube insertion, and hemoptysis, with adjustment for other risk factors. RESULTS: Pneumothorax occurred in 2298 of the 10568 biopsies (21.7%). Tube insertion was required after 316 biopsies (3.0%), and hemoptysis occurred in 550 cases (5.2%). In the multivariate analysis, pneumothorax was more frequently detected with CT {odds ratio (OR), 2.752 (95% confidence interval [CI], 2.325–3.258), p < 0.001}, CT fluoroscopy (OR, 1.440 [95% CI, 1.176–1.762], p < 0.001), and cone-beam CT (OR, 2.906 [95% CI, 2.235–3.779], p < 0.001), but no significant relationship was found for pneumothorax requiring chest tube insertion (p = 0.497, p = 0.222, and p = 0.216, respectively). The incidence of hemoptysis was significantly lower under CT (OR, 0.348 [95% CI, 0.247–0.491], p < 0.001), CT fluoroscopy (OR, 0.594 [95% CI, 0.419–0.843], p = 0.004), and cone-beam CT (OR, 0.479 [95% CI, 0.317–0.724], p < 0.001) guidance. CONCLUSION: Hemoptysis occurred less frequently with CT-based guidance modalities in comparison with fluoroscopy. Although pneumothorax requiring chest tube insertion showed a similar incidence, pneumothorax was more frequently detected using CT-based guidance modalities.
Biopsy ; Biopsy, Needle ; Chest Tubes ; Cohort Studies ; Cone-Beam Computed Tomography ; Ethics Committees, Research ; Fluoroscopy ; Hemoptysis ; Image-Guided Biopsy ; Incidence ; Informed Consent ; Lung Neoplasms ; Multivariate Analysis ; Needles ; Pneumothorax ; Referral and Consultation ; Retrospective Studies ; Risk Factors