A 53-Year-Old Man With Hemoptysis

Abstract

53-year-old black man presented with recurrent episodes of hemoptysis, with 1.5 cups of bright red blood expectorated over a 2-day period. He denied having fever, chest pain, vomiting, night sweats, shortness of breath, or dizziness. He had had a dry cough for several months before admission to the hospital. He also had lost 40 lb from dieting in the past several years. He was being treated for hypertension and gastroesophageal reflux disease. He had a 30-year history of tobacco use, occasional alcohol use, and no IV drug abuse. Clinical examination revealed a pleasant black man not in acute distress. Vital signs were stable: pulse rate, 79 beats/ min; BP, 154/92 mm Hg; and respiratory rate, 21 breaths/min. There was no clubbing or lymphadenopathy. Chest examination revealed scattered crackles at both lung bases. The rest of the physical examination was unremarkable. Laboratory investigation showed a hemoglobin level of 14.2 g/dL, a WBC count of 6.0 3 10 3 /mL, and a platelet count of 277 3 10 3 /mL. Prothrombin time was 24.2 s, and international normalized ratio was 0.88. Fiberoptic bronchoscopy revealed active oozing of blood from the left lower lobe bronchus with mildly edematous airways.