What Is the Source of This Man’s Hemoptysis?

AUTHORS:
Chetana Pendkar, MD • Kundan Jana, MBBS • Kalyana C. Janga, MD

AFFILIATION:
Maimonides Medical Center, Brooklyn, New York

CITATION:
Pendkar C, Jana K, Janga KC. What is the source of this man’s hemoptysis? Consultant. 2022;62(1):e6-e8. doi:10.25270/con.2021.04.00005

Received December 14, 2020. Accepted January 20, 2021. Published online April 13, 2021.

DISCLOSURES:
The authors report no relevant financial relationships.

CORRESPONDENCE:
Kundan Jana, MBBS, Maimonides Medical Center, 953 49th Street, Room 611, Brooklyn, NY 11219 (kjana@maimonidesmed.org)

A 29-year-old man presented to our emergency department with an episode of hematemesis associated with epigastric pain. This episode was preceded by excessive dry cough followed by emesis of food with mixed bright red blood clots. The patient reported that he had had similar episodes prior to this episode.

Initial therapy included intravenous proton-pump inhibitors, octreotide, and erythromycin because of a suspected upper gastrointestinal bleed prior to endoscopic confirmation.

A computed tomography scan of the chest demonstrated consolidative changes involving the right middle lobe and the lingular segment of the left upper lobe, accompanied by prominent tortuous mediastinal vessels (Figure).

Figure. A contrast-enhanced computed tomography scan of the chest.

Answer and discussion on next page.