[An autopsy case of massive hemoptysis due to a rupture of the thoracic aortic aneurysm into the left lung].

An 81-year-old man was admitted to our hospital with aspiration pneumonia and thereafter suddenly died of massive hemoptysis. An autopsy revealed an aortic arch aneurysm which had ruptured into the left lung. This case showed that acute infectious lung diseases, such as aspiration pneumonia, could cause a rupture of thoracic aortic aneurysms. Thoracic aortic aneuysms are uncommom causes of hemoptysis. Their rupture into the left lung is rarer than that into other organs and not many such cases have been previously reported in the literature. Making an accurate diagnosis is also difficult if an aneurysm is not suspected. Delay in surgical treatment could result in a lethal hemorrhage. In conclusion, we suggest that thoracic aortic aneurysms should always be considered and carefully ruled out in patients who present with either massive or minor hemoptysis.

[Case of intractable hemoptysis controlled by bronchial occlusion with an Endobronchial Watanabe Spigot (EWS)].

A man in his eighties with massive hemoptysis was referred to our hospital in order to control the bleeding. Chest computed tomography (CT) indicated that the hemoptysis originated from the right upper lobe. We performed arterial embolization twice, but failed to stop it. A surgical lobectomy was considered to be very difficult to perform because of his poor general condition and the strong adhesions between the right upper lobe and parietal pleura. We therefore performed fiberoptic bronchoscopy and plugged 4 EWS (Endobronchial Watanabe Spigot) into his right B1b, B1, B2, B3, and this procedure was able to successfully and completely control the hemoptysis. Bronchial occlusion with EWS has been developed in order to treat patients with intractable pneumothorax, pyothorax with bronchial fistula and similar problems. Our findings suggest that this method is also highly effective in controlling hemoptysis in cases in which arterial embolization is unable to stop the bleeding or surgery is difficult to perform.