Signs and Symptoms of Chest Diseases: Student/Resident Case Report Poster - Signs and Symptoms of Chest Disease |

A Rare Case of Hemoptysis Due to Pyogenic Granuloma in Lung FREE TO VIEW

Shweta Kambali, MBBS; Mohd Kanjwal, MD; Shrinivas Kambali, MD
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St. Marys of Michigan, Saginaw, MI

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1254A. doi:10.1016/j.chest.2016.08.1367
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SESSION TITLE: Student/Resident Case Report Poster - Signs and Symptoms of Chest Disease

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Introduction: Hemoptysis is expectoration of blood which can vary between minimal blood streaking of the sputum to massive hemoptysis.1 2 Common causes for hemoptysis are acute bronchitis, bronchiectasis, neoplasm, infection, coagulopathy, iatrogenic, autoimmune conditions and pulmonary embolism. In about 30% of the cases it can be cryptogenic in nature.3 We present a rare case of hemoptysis secondary to pyogenic granuloma in the lung.

CASE PRESENTATION: Case: A 74 yo Caucasian male presented to the emergency room with symptoms of acute hemoptysis. He woke up at middle of night with symptoms of acute cough and he noticed bright red blood about a 10-15ml. He had repeated episodes of hemoptysis in the ER. He did not have any symptoms of fever, chills or sweating. Past medical history: No history of prior hemoptysis. He had history of CAD with CABG. Medications: Plavix 75 mg daily and aspirin 81mg daily. Family history: Lung cancer in sister. Social history: Remote history of chewing tobacco. Exposure to asbestos. On examination: Pulse: 116/min. Sat: 97% on 3L oxygen Chest: crackles in right lung base. Chest was resonant on percussion. CTA chest: No PE. Alveolar opacities in the right lower lobe. Bronchoscopy: Revealed large blood clot in right lateral basal sub segment which was suctioned. There was small area of submucosal abnormality which was dark purple color and about a centimeter in size without any elevation above the mucosal layer. Endobronchial biopsy was done from the mucosa to rule out malignancy. Broncho-alveolar lavage and washings were negative for AFB, fungus and bacteria. Biopsy: Revealed normal mucosa with proliferation of the small capillary sized blood vessels resembling pyogenic granuloma. No malignant cells were seen. Final diagnosis: Hemoptysis due to pyogenic granuloma in the right lower lobe submucosal layer.

DISCUSSION: Discussion: Pyogenic granuloma is a benign vascular tumor of the skin and the mucous membrane characterized by friable surface. It can occur at any age and it is seen more often in children and young adults. In a review of 325 cases 86% of the lesions were in the skin and 14% in mucosal layer. It is predominantly seen in the head and neck area with predominance in the lip and gingival mucosa.4 Common treatments for cutaneous lesions include surgery with excision or curettage, laser treatment, cryotherapy or topical or intraepithelial therapy with sclerotherapy, intralesional corticosteroids, bleomycin and ligation. No cases have been reported with occurrence in the endobronchial mucosal layer. There is no defined treatment modalities for pyogenic ganuloma in the lung. If there is recurrence or persistence of hemoptysis treatment modalities like laser or cryotherapy may be helpful in distal lesions.

CONCLUSIONS: Hemoptysis can occur due to rare conditions like pyogenic granuloma in the lung.

Reference #1: Eur Respir J. 2008;32(4):1131.

Reference #2: Emerg Med Clin North Am. 2003 May;21(2):421-35.

Reference #3: Am J Respir Crit Care Med. 2007;175(11):1181.

DISCLOSURE: The following authors have nothing to disclose: Shweta Kambali, Mohd Kanjwal, Shrinivas Kambali

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