ABSTRACT
A 13-year-old girl was admitted with massive hemoptysis and hematemesis. An estimated volume was about 400 cc. The blood was frothy and mixed with sputum and food. She had no history of epistaxis, choking, joint pain or trauma. Her vital sign was stable and physical examination was normal except for bilateral crackles and ronchi on auscultation of the lungs. Laboratory data on arrival including blood counts, liver enzyme, urinalysis and electrolytes were all normal. Chest CT showed bilateral extensive centrilobular ground glass opacity nodules and there were suspicious blood clots in the right bronchus. There was no evidence of pleural effusion, increased vascular markings, abscess or brochiectasis. We performed an upper GI endoscopy and bronchoscopy, it was all normal. On cytology from bronchoalveolar lavage, cell count was 1,660/microL with 63% of macrophages laden with erythrocytes and 35% lymphocytes. Tuberculosis PCR from this fluid was negative and AFB stain, Gram stains were all negative. She has had a second attack on day seven, emergency bronchial angiography was performed. There was dysplastic bronchial artery with a tortuous change, shunting to the pulmonary artery. Bronchial artery embolization was performed successfully using embolization particles. Follow-up blood counts, electrolytes and chest radiogram were all normal. There was no further episode of hemoptysis twelve months after embolization.