Hematic mold of the bronchial tree after balloon pulmonary angioplasty.

Abstract

A 72-year-old woman with peripheral-type chronic thromboembolic pulmonary hypertension underwent balloon pulmonary angioplasty (BPA). Initial right heart catheterization revealed a pul monary arterial pressure of 60/15 mmHg, mean pressure of 31 mmHg, pulmonary arterial wedge pressure of 8 mmHg, and pulmonary vascular re sistance of 5.94 Wood units. The right A1, A3, A5, A8, A9, and A10 segments and the left A8, A9, and A10 segments were treated for 1st BPA (Fig. 1A, B, Suppl. Video 1). Ten minutes after the procedure, the patient developed hemoptysis. Pulmonary vessel injury was suspected, and non-invasive positive pressure ventilation was initiated. After 3 hours, hemoptysis disappeared. Echocardiogra phy showed improved pulmonary hypertension; however, hypoxia persisted. Computed tomography showed an infiltrative shadow in the right supe rior apical and middle medial lobes. Moreover, a space occupying lesion was detected in the right intermediate bronchus (Fig. 1C, D). The patient experienced a hacking cough and spontaneously ex pectorated a large blood clot shaped like a bronchial tree (Fig. 1E). After the removal of the blood clot, her oxygenation and dyspnea symptoms improved.