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Objective: Management of emergency care Background: Hemoptysis due to airway hemorrhage is treated with hemostatic agents, bronchial artery embolization (BAE), or surgical resection. We present the case of a 65-year-old man with refractory hemoptysis associated with chronic progressive pulmonary aspergillosis (CPPA) who failed to respond to combined endobronchial occlusion (EBO) with endobronchial Watanabe spigot (EWS) and BAE. Case Report: A 63-year-old man was diagnosed with CPPA in the right upper lung and presented to our hospital 2 years later for hemoptysis at age 65. He developed severe hemoptysis during an outpatient visit, and was urgently admitted, intubated, and ventilated to prevent choking on blood clots. Chest computed tomography showed a large mass in the apical portion of the right lung, constituting apical pleural thickening and an encapsulated pleural effusion, and dilatation in the bronchial artery supplying the right upper lung lobe. Bronchoscopy revealed the right upper lobe B1-B3 as the bleeding source. The patient had recurrent hemoptysis that was not controlled by BAE or 6 EBO+EWS procedures, and he ultimately died of hypoxemia. In the literature review, EBO+EWS can effectively control hemoptysis in appropriate cases, without the need for BAE or surgical lung resection. It is less invasive, is associated with fewer adverse events than BAE or surgery, and can achieve temporary hemostasis for severe hemoptysis. Conclusions: BAE and EBO+EWS were ineffective in controlling recurrent hemoptysis caused by CPPA in this case. However, a multidisciplinary approach such as attempting hemostasis with combined EBO+EWS and BAE may be a viable treatment option in severe cases of hemoptysis. [ABSTRACT FROM AUTHOR]

Case series Patients: Male, 73-year-old * Female, 79-year-old * Male, 45-year-old * Male, 76-year-old * Female, 63-year-old * Male, 43-year-old Final Diagnosis: Aspergillus fumigatus infection * hereditary haemorrhagic telangiectasia * lymphangioleiomyomatosis * tuberculosis Symptoms: Hemoptysis Medication: -- Clinical Procedure: Angiography * CT scan * embolization Specialty: Pulmonology * Radiology Objective: Unusual clinical course Background: Although bronchial arteries are the most common cause of hemoptysis, other systemic arteries can cause hemoptysis and are potential pitfalls for successful embolization. Case Reports: We present 6 cases of hemoptysis showing vascularization from systemic arteries other than bronchial arteries that presented to our department between 2013 and 2020. Chronic inflammatory diseases such as tuberculosis and pulmonary aspergillosis were the underlying diseases in 4 of the 6 cases. In all 6 cases, the lesions were close to the pleura. The abnormal non-bronchial systemic arteries were the internal thoracic artery in 4 cases, intercostal artery in 2 cases, lateral thoracic artery in 2 cases, and the subclavian, thyrocervical, and inferior phrenic arteries in 1 case each, all of which formed a shunt with the pulmonary artery. Additionally, depending on the location of the lesion, the non-bronchial systemic arteries near the lesion proliferated into the lung parenchyma through the adherent pleura. Conclusions: When lesions are in contact with the pleura, various non-bronchial systemic arteries near the lesion can develop in the pulmonary parenchyma via the adherent pleura, which can cause hemoptysis. In patients with hemoptysis, it may be useful to evaluate chest contrast-enhanced computed tomography and angiography, while always accounting for the potential involvement of non-bronchial systemic arteries to ensure a safer and more reliable treatment. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course Background: Cytomegalovirus (CMV) pneumonia is common in immunocompromised patients with hematological malignancies. Although the spectrum of illness caused by CMV is well-documented in immunocompromised patients, the clinical course and evolution of lung changes after initiation of antiviral therapy remain unclear. Case Report: We present the cases of 3 patients with leukemia who developed CMV pneumonia following cord blood transplantation and who presented with distinctive features on chest computed tomography (CT). In all patients, chest CT showed central peribronchial changes with severe lung volume loss. Furthermore, the patients were refractory to high-dose steroids, and the lung volume loss rapidly progressed, leading to death from respiratory failure. Conclusions: We observed central peribronchial changes with severe lung volume loss after the acute phase in 3 cases of CMV pneumonia. While our diagnosis was made on the basis of exclusion, it is important to bear in mind that lung involvement in CMV pneumonia may be refractory to various treatment modalities and can lead to a fatal clinical course. [ABSTRACT FROM AUTHOR]