An Unusual Presentation of “Post-tuberculous Bronchiectasis


      INTRODUCTION: Bronchiectasis is the permanent dilatation and destruction of bronchi with potential to cause devastating illness. We report a case of huge bronchiectatic cavity causing massive hemoptysis.
      CASE PRESENTATION: A 45 year-old Afghani gentleman presented to our hospital with massive hemoptysis of about 1 liter of bright red blood over 2 days. He denied having fever,chest pain,night sweats or weight loss. He had a history of Pulmonary tuberculosis 4 years back. For the past 1 year he had productive cough. He had a 40 pack-year history of smoking. Clinical examination revealed a cachectic gentleman with heart rate of 110,BP 80/60,respiratory rate 26 and finger clubbing. Chest examination revealed hyperresonance with diminished breath sounds over the left anterior side. Rest of the physical examination was unremarkable. Laboratory investigation showed hemoglobin 10.8,WBC count 23000 with neutrophilia, platelet count 595,000,normal PT and PTT,and PaO2 of 53.3mmHg on room air. Chest Radiograph (Figure 1) on admission showed large cavities with volume loss in the left lung.CT Scan revealed extensive fibrosis and bronchiectasis in the left lung. Right lung showed less severe fibrosis(Figure 2, 3). Fiberoptic bronchoscopy revealed two large ’holes’ in the left upper lobe bronchus communicating with a cavity (Figure 4). Bleeding vessels were identified in the cavity. Epinehrine was used for local control of bleeding followed by left bronchial artery embolization (Figure 6,7, 8).
      DISCUSSION: Bronchiectasis is a disease of bronchi and bronchioles involving a vicious cycle of transmural infection and inflammation. Post-inflammatory bronchiectasis remains very common in developing countries as a sequelae to pulmonary tuberculosis. Anatomic changes occur in bronchial vessels adjacent to bronchiectatic segments, such as bronchial artery hypertrophy, expansion of peribronchial and submucosal bronchial arteriolar plexus and anastomoses with the pulmonary artery bed. Bleeding can originate from either enlarged, tortous bronchial vessels or rich submucosal plexus in the wall of bronchiectatic segments. Rupture of such a vessel can result in massive hemoptysis.
      CLINICAL IMPLICATIONS: This represents a case of huge bronchiectatic cavities resulting in lifethreatening hemoptysis. Post tuberculous bronchiectasis remains very common cause of massive hemoptysis in developing countries like Pakistan.
      DISCLOSURE: A.B. Zubairi, None.
      Wednesday, October 29, 2003
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      1 Indian J. Pediatrics67(2)2000Feb133–139
      2 Singapore Med J.40 (02). 1999;