Massive Pulmonary Hemorrhage from Bronchial Varix

Abstract

Bronchial varix is a rare pulmonary disorder which may lead to life-threatening hemorrhage. Diagnosis is difficult because of the subtle abnormalities on radiographic and bronchoscopic examination. We present a case of massive hemoptysis from a bleeding bronchial varix. In the absence of immediate complex endobronchial therapy in the island of Guam, this case was initially managed with nebulized and intravenous tranexamic acid. This was followed by endobronchial blockade of the bleeding airway with endobronchial epinephrine instillation. Selective bronchial artery embolization alleviated the acute-phase bleeding. Prone positioning was initiated due to severe hypoxia after blood clots compromised the patency of bilateral bronchial airways. Prone ventilation was employed for 17 hours for 2 consecutive days with intermittent bronchoscopic forceps extraction of airway blood clots while in the prone position. These maneuvers resulted to improved lung ventilation and oxygenation. The patient underwent bronchial sleeve resection surgery for definitive management.

Life‐Threatening Subglottic Thrombus Formation after Administration of Nebulized Tranexamic Acid

“…Coagulation can precipitate obstructive clot formation and lead to further complications. Researchers previously described a case of hemoptysis due to bronchial varix that was treated with nebulized TXA and bronchial artery embolization 3 . The patient became severely hypoxic and went into cardiac arrest.…”

“…Researchers previously described a case of hemoptysis due to bronchial varix that was treated with nebulized TXA and bronchial artery embolization. 3 The patient became severely hypoxic and went into cardiac arrest. Bronchoscopy revealed bronchial airway thrombi that were subsequently removed.…”