Massive Hemoptysis Secondary to Behçet’s Aneurysm Controlled with Endobronchial Balloon Lung Isolation (Case Report and Review of Literature)
CCCF ePoster library. AL BSHABSHE A. Nov 8, 2018; 233340
ALI AL BSHABSHE
ALI AL BSHABSHE
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Abstract
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Introduction

Behçet’s disease is a multisystem disorder first described by Hulusi Behçet in 1937. It is a vasculitis that presents with a triad of recurrent ulcers of the oral and genital mucosa with relapsing uveitis. Among the systemic vasculitides, Behçet’s syndrome is remarkable for its ability to involve blood vessels of all sizes on both the arterial and venous sides of the circulation.1the most commonly affected arteries are the aorta, pulmonary arteries and femoral artery.2

Case report

45yrs old, male, known to have Behçet’s disease for 6 years, which is complicated by recurrent Deep vein thrombosis, Pulmonary embolism (fig1) And left pulmonary artery aneurysm which underwent coiling embolization tow months back (fig 2, 3).

Currently, he presented with mild hemoptysis over the preceding three days, which was associated with shortness of breath and chest pain. The hemoptysis gets worse 2 hours before his presentation with massive hemoptysis (around 1200 ml of fresh blood .he became hypoxic agitated for that immediately he was intubated and mechanically ventilated.

He continues to have hemoptysis and hypoxemia (spo2 60%)on 100 fio2 for that an emergency fiberoptic bronchoscopy undertaken and the left lung was isolated using endobronchial balloon occlusion (fig 4) and the blood clots were removed from the right bronchial tree using forceps . the patient saturation improved and he gets admitted to the critical care unit. 24 hours later the balloon gets deflated and the bleeding stopped after that the patient get planned by the cardiothoracic team for surgical intervention. He gets extubated and discharges from the ICU later in good condition.

Discussion

Behcet's syndrome is a rare multisystem disorder of unknown etiology presenting with recurrent oral and/or genital ulcerations, chronic relapsing uveitis which may cause blindness and/or neurological impairments.3,4,5

Vascular system involvement is observed in 20% to 40% of patients with Behcet's disease. Venous and arterial involvement is seen in BD. 2

PAA is the most common lung manifestation of BD, which is the most common cause of PAAs. Additional parenchymal findings, including atelectasis, hemorrhage, and infarction (focal or subpleural consolidation), have also been reported. These are commonly encountered secondary to thrombosis of the pulmonary vessels. Pneumonia, bronchitis, fibrosis, subpleural infiltrates, subpleural nodules, pleural effusion, and emphysema have been described. 6

Massive hemoptysissis had multiple definitions but the most plausible one is the volume that is life-threatening either leading to airway obstruction or blood loss 7. In cases with behcets diseases usually happened in those who had pulmonary artery aneurysm 8. Using endobronchial balloon in massive hemoptysis, for isolation of a bleeding segment with a balloon may prevent aspiration of blood into the large airways, thereby maintaining airway patency and oxygenation 9. The ballon can stay in the airway for 24 hours which can be single or double lumen 10.

In this patient, there was no time for rigid bronchoscope, angioembolization or surgical intervention where the most feasible option at that time is single lung isolation and clot removal using fiberoptic bronchoscope which was very beneficial and life-saving.

Conclusion 

Massive hemoptysis is a life-threatening respiratory emergency and we need to have multiple options to control it. bronchoscopic endobronchial balloon isolation is one of the modalities which is feasible and can be life-saving.


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