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Case Report: Massive Hemoptysis From A Spontaneously Regression Inflammatory Bronchial Polyp

Iwamoto, Y. 2022Other/Unknown

Iwamoto, Y., Takenouchi, H., Koyama, K., Shirai, R., Kaneto, H., & Tomoda, K. (2022). Case Report: Massive Hemoptysis From a Spontaneously Regression Inflammatory Bronchial Polyp. Frontiers in medicine, 9, 875311. https://doi.org/10.3389/fmed.2022.875311

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Abstract

BACKGROUND: Bronchial inflammatory polyps are usually treated by surgical operation or with steroids and/or antibiotics, and it is quite rare that such polys spontaneously disappear without any treatment. This report shows a rare case with a bronchial inflammatory polyp which caused massive hemoptysis but spontaneously disappeared without any treatment. CASE PRESENTATION: A 66-year-old man with type 2 diabetes mellitus and a history of cough and asthma suddenly developed massive hemoptysis while smoking and was brought to an emergency room in our institution. In bronchoscopy on admission, a polypoidal elevated lesion was observed in the left upper lobe bifurcation. Pulsatile hemorrhage from a polypoidal elevated lesion was observed upon stimulation of passage of the bronchoscope. Bronchoscopy performed 25 days after discharge showed no evidence of active bleeding and a tendency toward reduction of the elevated lesion. In bronchoscopy performed 106 days after the initial hospitalization, the bronchial inflammatory polyp completely disappeared. CONCLUSIONS: We should bear in mind the possibility of spontaneous disappearance of bronchial inflammatory polyps causing some serious symptoms such as massive hemoptysis and repeated bloody sputum. Finally, we should select the best therapy for bronchial inflammatory polys based on each patient's background and conditions in clinical practice.

Case Details

Disease Location

Bronchial tree

Personal Characteristics

66-year-old man. History of type 2 diabetes mellitus treated with 50mg of vildagliptin and asthma. Smoking history of 60 pack years.

Clinical Characteristics

Presented with massive hemoptysis of more than 1l while smoking 2 days before. A chest radiograph on admission demonstrated reticular shadows in the right lower lung fields. CT showed frosted shadows in the dorsal left upper lobe and left lower lobe. The left lower lobe showed ground-glass opacity and fibrotic and cystic changes. Bronchoscopy revealed a polypoidal elevated lesion in the left upper lobe bifurcation. Passage of the bronchoscope revealed pulsatile bleeding from the periportal area of the polyp. Thrombin was applied under bronchoscopy, and hemostasis was achieved. The patient was empirically treated with carbazochrome, carbocisteine, and cloperlastine with symptomatic relief. Follow-up bronchoscopy on day 25 post discharge which showed no evidence of active bleeding. The polypoidal nodule appeared less pronounce and an endobronchial biopsy was performed. Histopathology demonstrated a foci of reactive myofibroblast growth from the bronchial mucosa to the endobronchial palace suggestive of a bronchial inflammatory polyp

Remission Characteristics

Bronchoscopy was performed 106 days after the initial hospitalization. As the results, the bronchial inflammatory polyp completely disappeared. On follow-up chest imaging, the lower lobe infiltrates had resolved with residual underlying fibrotic changes.

Treatment & Mechanisms

Clinical Treatment

Biopsy, thrombin