Massive Hemoptysis in Severe Idiopathic Pulmonary Hypertension A Rare Presentation

Abstract

Hemoptysis is not an uncommon presentation of a disease in a pulmonologist’s usual practice. The significance of hemoptysis comes from the fact that even a minimal amount of intrabronchial bleeding can lead to life-threatening airway compromise and escalate the mortality risk. Infections such as tuberculosis and other bacterial or fungal parenchymal infectious causes are often cited as major culprits in hemoptysis cases. We present an unusual case of a young gentleman with no prior comorbidities who initially presented with nasal bleeding and over a span of 2 weeks experienced two major episodes of hemoptysis. He underwent multiple imaging studies and bronchoscopic evaluations but was eventually found to have elevated pulmonary pressures on echocardiogram and a pattern of right heart strain on electrocardiogram. These findings shed light on a rare presentation of idiopathic pulmonary hypertension being the cause of massive hemoptysis. This case was an eye-opener for many reasons including missing important cardiac examination findings during the clinical evaluation and the presence of a dilated pulmonary trunk in contrast CT images ultimately unravelling one of the rarest causes of massive hemoptysis.