A rare and fatal respiratory disease: bronchial Dieulafoy's disease

A 66-year-old woman had two severe episodes of massive hemoptysis without any premonitory symptoms, with approximately 400–500 ml blood each time. Bronchoscopic exam revealed a smooth and pulsatile protrusion that was approximately 8–10 mm in diameter found at the beginning of the right middle lobe bronchus in the bronchial lumen. The protrusion arose from the surface with absolutely normal mucosa. Selective bronchial arteriography showed that elongated, tortuous, and dilated branches of the bronchial artery in the region of the middle lobe bronchus. Further bronchial arterial embolization (BAE) is recommended, although the patient currently has no active bleeding. Bronchial Dieulafoy’s disease (BDD) is a rare and life-threatening disease. Selective bronchial arteriography is a diagnostic tool to detect and locate abnormal arteries. There is no unified guideline or expert consensus on the treatment of BDD. Selective BAE or surgical resection is usually used as a first-line treatment to control hemoptysis.

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Dieulafoy disease of the bronchus involving bilateral arteries: A case report and literature review

RATIONALE

Dieulafoy disease of the bronchus is a rare vascular deformity. To the best of our knowledge, reports of these involving both lung vascular are hitherto absent.

PATIENT CONCERNS

A 67-year-old male was admitted to our department due to agnogenic hemoptysis.

DIAGNOSES

Bronchoscopy was performed and some smooth, pulsatile nodular lesions were found in the middle and lower lobes, Computed tomography angiography of the bronchial artery confirmed a left bronchial artery arising from the aortic arch at T4 level, and both bronchial arteries were dilated and tortuous.

INTERVENTIONS

Bronchial artery embolization was performed successfully.

OUTCOMES

The patient was discharged with no hemoptysis. In addition, patient is under follow-up until today without any further incidents.

LESSONS

This case reminds us that Dieulafoy disease of the bronchus could be a potential etiology for unexplained hemoptysis. The clinician should be aware of this disease when bronchoscopy revealed multiple some smooth, pulsatile nodular lesions, thereafter, bronchoscope biopsy should be avoided, as it could lead to fatal hemoptysis.