Case report: A rare cause of haemoptysis in a male with unprovoked deep venous thrombosis

Abstract

A 29 year-old previously healthy Egyptian male complained of a 4-day vague abdominal pain for which he underwent an abdominal ultrasound. An inferior vena cava (IVC) thrombus was suspected by the sonographer who recommended undergoing an abdominal computed tomography (CT) with intravenous contrast. The IVC thrombus was confirmed by CT, but the study did not delineate any cause for the thrombus or any additional abdominal pathology. The basal chest scans revealed multiple peripheral cavitary nodules in both lower lung lobes. The patient was referred to our institution for evaluation of the pulmonary lesions. At the time, the patient only complained of an occasional cough and a small amount of mucopurulent sputum, but no chest pain. He was moderate smoker and substance abuser (tramadol and cannabis). The patient strongly denied i.v. drug abuse as well as taking any medications.

Pulmonary vasculitis in Hughes-Stovin syndrome (HSS): a reference atlas and computed tomography pulmonary angiography guide—a report by the HSS International Study Group

“…In one case, a patient died after PAA involving the main pulmonary artery (PA), ruptured into the pericardial space [ 4 ]. Overall, the main cause of death in HSS is typically fatal hemoptysis due to PAA or PAP rupture [ 1 – 9 , 23 , 29 , 30 , 35 ] as a result of unremitting pulmonary vasculitis. This clearly indicates that early detection and close subsequent surveillance of pulmonary vascular lesions should be a top priority in the management of HSS patients [ 10 ].…”

A critical analysis of 57 cases of Hughes-Stovin syndrome (HSS). A report by the HSS International Study Group (HSSISG)

“…In our report massive hemoptysis was the cause of death [1,2,[7][8][9]27,33,34,39,47] in 12(21.1%) patients. Early initiation of immunomodulatory drugs, either as single agents or in combination were significantly associated with favorable outcomes and a lower rates of mortality.…”

“…Hughes and Stovin [1] highlighted that in addition to PAAs, bronchial arteries can become involved by the same process. Currently, typical pulmonary findings are confirmed by CTPA, which has been supplemented with multiplanar reconstruction (MPR) [13][14][15][16][17][18][22][23][24][26][27][28][29][30][31][32][35][36][37][39][40][41][42][44][45][46], 3D VRT software [19,22,33,36,44,45], and pulmonary MRA [15,18,26,38,40] in recent reports. Hughes and Stovin [1] also documented that the primary features seen in their two cases were consistent with those reported earlier by Beattie and Hall in 1912 [2] and Pirani et al in 1949 [3].…”

“…3a and c). This radiologic pattern can progress to fatal suffocative hemoptysis [ [1][2][3][4][7][8][9][10][11]27,33,34,39,47]. As such, we consider pulmonary artery pseudoaneurysms (PAPs) to be the most common cause of fatal hemoptysis in HSS.…”

“…Computed tomography (CT) scanners from each international center [13][14][15][16][17][18][22][23][24][26][27][28][29][30][31][32][35][36][37][39][40][41][42][44][45][46] were used to acquire images of the thorax in a caudocranial direction. In all studies, the chest field of view (FOV) is considered to be the widest rib-to-rib distance acquired during breath hold after inspiration.…”