Spontaneous Bronchial Tear After Severe Coughing In An Old Female

Abstract

IntroductionSpontaneous tears of the mucosal layers are well known in esophagus after severe bouts of vomiting. But severe bouts of cough leading to a tear in the bronchial tree is not commonly seen and not reported yet. We report this rare occurrence in an immunocompromised female with respiratory infection. Case presentation A 60 year old female with Chronic kidney disease secondary to Vasculitis on immunosupressive medication and maintenance hemodialysis presented with severe cough over 2 days associated with hemoptysis of moderate quantities. She had left lower lobe consolidation with mild pleural effusion on chest radiograph and Computerized Tomogram of chest (Figure1). She was in respiratory distress and required invasive ventilation. Routine investigations and coagulations parameters like PT, APTT, Platelet count were normal. She was not on any anticoagulant medication. A Flexible Bronchoscopy was performed through the Endotracheal tube. It revealed a tear ( Figure. 2) along the junction of left upper and lower lobe bronchi measuring about 1cm length and 3-4 mm wide rough floor oozing fresh blood. Broncho alveolar lavage (BAL) collected from the left lower lobe was turbid but not grossly hemorrhagic. Cytological analysis of BAL revealed few Red blood cells and predominant Neutophils. Subsequently BAL Culture had grown Pseudomonas which was treated with appropriate antibiotics. Her hemoptysis stopped eventually and she was extubated and discharged after, in stable condition. Discussion Tears in the bronchial tree are almost always trauma related and spontaneous tears are not generally heard of. On detailed review of