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• W2765853470 abstract "SESSION TITLE: Bronchoscopy and Associated Procedures SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Bronchial diverticular bleed is rarely identified as a cause of chronic hemoptysis. Lack of detection on regular CT often delays diagnosis. CASE PRESENTATION: A 50-year-old African American male non-smoker presents with chronic hemoptysis of 6 months’ duration. He has been coughing up a teaspoonful of dark blood twice daily. He received azithromycin without improvement. On physical examination, he has left basilar crackles without clubbing. Laboratory tests showed normal complete blood count and INR, negative HIV screen and Quantiferon Gold. CT angiogram chest redemonstrated left lower lobe consolidation. Bronchoscopy disclosed one bleeding bronchial diverticulum in the basal segment of the left lower bronchus. It was successfully injected with epinephrine. Small amount of hemoptysis recurred, prompting a repeat bronchoscopy. Same bleeding diverticulum was reidentified. Injection of fibrin sealant achieved hemostasis and hemoptysis resolved. DISCUSSION: Bronchial diverticula can be observed in asymptomatic non-smokers, although their occurence is more prevalent in smokers with COPD at 45%. They tend to be isolated, subcarinal, less common in lobar bronchi, with slight predilection for male sex. Chronic inflammatory tracheobronchial changes and increased endoluminal pressure are most important etiologic factors. Their 1-2 mm size requires a multidetector row CT(MDCT) to be visualized. These submicroscopic depressions of the bronchial mucosal surface act as a reservoir of secretions. Thus, patients develop chronic cough, hemoptysis or recurrent infections. Therapeutic bronchoscopy with instillation of fibrin sealant can achieve hemostasis as illustrated in this case. CONCLUSIONS: Bronchial diverticular bleed should be considered in the differential diagnosis of chronic hemoptysis. While MDCT is usually diagnostic, bronchoscopic visualization of bleeding diverticula is required before hemostasis can be achieved. Reference #1: Ciccarese F, Garzillo G, Chiesa AM, Poerio A, Baroncini S, Bacchi Regiano ML, Sverzellati N, Zompatori M. Incidental finding of bronchial diverticula in a non-smoker population: evaluation on thin-section CT. Monaldi Arch Chest Dis 2016;81(1-2):743 Reference #2: Brillet PY, Fetita CI, Saragaglia A, et al. Investigation of airways using MDCT for visual and quantitative assessment in COPD patients. Int J Chron Obstruct Pulmon Dis 2008;3:97-107 Reference #3: de Gracia J, de la Rosa D, Catalan E, Alvarez A, Bravo C, Morell F. Use of endoscopic fibrinogen-thrombin in the treatment of severe hemoptysis. Respir Med 2003;97(7):790-795 DISCLOSURE: The following authors have nothing to disclose: Zahia Esber, Mark Vollenweider No Product/Research Disclosure Information" @default.
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• W2765853470 title "An Unusual Bleeding Suspect Presenting as Pneumonia" @default.
• W2765853470 doi "https://doi.org/10.1016/j.chest.2017.08.887" @default.
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