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A Paraspinal Screw Within The Lung Parenchyma: An Unusual Cause of Massive Hemoptysis FREE TO VIEW

Mohammed Alzoubaidi, MBBS; Wendy Hsu, MD; Wei Shen, MD; Dena L'heureux, MD
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University of Arizona, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Tucson, AZ

Chest. 2013;144(4_MeetingAbstracts):26A. doi:10.1378/chest.1705314
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SESSION TITLE: Bronchology Case Report Posters II

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: There are numerous causes of hemoptysis. We present an usual cause of massive hemoptysis.

CASE PRESENTATION: A 34 year old lady presents to the emergency department complaining of hemoptysis. She coughed more than 200ml of blood within the last 2 hours prior to admission. Hemoptysis had stopped upon arrival to the emergency department. The patient has had episodes of hemoptysis in the past that were self limiting and comprised of coughing blood streaked sputum. The patient has a past medical history significant for a giant cell tumor involving the sixth thoracic vertebra that was resected in 2007. The tumor recurred and upon follow up in 2010 the mass had enlarged to 10cm in diameter and had invaded three vertebral bodies and four ribs. She underwent radiation therapy and chemotherapy, followed by tumor resection, spinal fixation and right lung lower lobe partial resection in 2011. The patient was admitted to the ICU for observation. A CT angiogram of the chest revealed a right bronchopleural fistula and a right paraspinal screw within the fistula. A bronchoscopy was performed. A paraspinal screw was seen at the distal end of the broncus intermedius, transversing the subcarina from the medial to lateral aspect. The thoracic and neurosurgical services operated on the patient. Due to instability of her spine, they opted to perform a right middle lobe resection and a stump was created at the end of the bronchus intermedius. A repeat bronchoscopy revealed a well healed stump at the end of the bronchus intermedius.

DISCUSSION: The patient has had previous self limiting episodes of hemoptysis that were attributed to the surgery, partial lower lobe lobectomy. Previous CT images of the chest performed prior to this admission had commented on a “possible” bronchopleural fistula yet never on the location of the paraspinal screw.

CONCLUSIONS: This case underlines the importance of bronchoscopy in localizing and controlling the source of bleeding if the source of bleeding is unknown1. The direct visualization of the source of bleeding can guide therapy and clarify ambiguities noted on imaging of the chest.

Reference #1: Cahill BC, Ingbar DH. Massive hemoptysis. Assessment and management. Clin. Chest Med. 1994;15(1):147-167

DISCLOSURE: The following authors have nothing to disclose: Mohammed Alzoubaidi, Wendy Hsu, Wei Shen, Dena L'heureux

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