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.
Highlights
Pulmonary varix is a rare pulmonary venous disorder characterized as aneurysmatic venous dilatation
We present a case of massive hemoptysis from a bleeding bronchial varix
We present a case of a massive hemoptysis from a bleeding left bronchial varix
Summary
Pulmonary varix is a rare pulmonary venous disorder characterized as aneurysmatic venous dilatation. In the absence of a complex pulmonary interventional therapy at our facility in the island of Guam, tranexamic acid nebulization and selective bronchial artery embolization were initiated. These procedures were followed by multiple manual forceps extraction of large airway blood clots via bronchoscopy while the patient is on prone position ventilation. Embolization of a bronchial artery on a bleeding bronchial varix has been reported by Shweihat and Zoby [2] Likewise, this hypothesis of enhance airway drainage with the prone position in pulmonary hemorrhage is discussed only on very limited case reports [3, 4]
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