a case of bleeding from the bronchus aneurysm and
a pulmonary hemorrhage :

74 years old, man main :
cheif complaint:Blood phlegm
Incumbent medical history : He was seeing a doctor regularly but
has never recognized blood phlegm so far even in high blood pressure
for the past .
There is previous history of brain infarction, and internal use does panarugin.
There were feeling that a bone was clogged to a cough, a throat
from June 11, blood phlegm, and he was examined at the clinc on
June 14.

A permeation shadow was recognized by the chest X-ray photograph
in both pulmonary fields, and ihe was hospitalized entered Tokuyama medical association hospital with the purpose of the thorough examination.
At the time of the hospitalization, incumbent condition :
Blood pressure 150/86, the pulse 80/min, a temperature 36.4° C,
chest auscultation were examined, and rales sound was heard in the
both sides back part (the left < the right).

There are no unusual views in the abdomen.

Blood gas analysis :(Air inhalation)
PaO2 57.4mm Hg, PaCO2 41.7mm Hg, pH 7.407,
WBC 10400, Hgb 12.2g/dl, Hct 34.3%.CRP 0.5m g/dl, ESR 35mm /1h, CH50 49.6U/ml, under MPO-ANCA 10

The chest X-ray photograph : A permeation shadow is recognized
inboth bottom pulmonary fields.



Chest CT:

Progress : Every day, there was blood phlegm, and the blood phlegm of the quantity 30 - 50g was recognized for 1 day in phlegm.
Though there was a shadow in the both sides pulmonary field with the chest X-ray photograph, the chest CT and thought about the possibility of pulmonary alveolar bleeding by the blood vessel flame, too.
It thought that the possibility of sponataneuou bronchus bleeding was high, and a bronchoscopur was carried out.
The first bronchoscopy
(June 16)
The right main bronchus has large quantities of blood lumps from the trachea, and there is adhesion of the new fresh blood in the leaf entrance part as well in the right.
There is blood adhesion in the left main bronchus as well.
The second bronchoscopy
(June 20)
New fresh blood isn't recognized though blood adhesion is recognized in the right main bronchus and the middle bottom leaf branch as well from the trachea.
The third bronchoscopu
(June 26)
The old blood lump which congealed in the trachea is recognized.
Fresh blood isn't recognized in the right main bronchus.
When the bottom left broncus branch was further observed and the upper left leaf branch were examined, there was a rising up of the half-globular form in the part B6 entrance, and it was diagnosed as the bronchus aneurysm from the left main bronchus.
Though there was blood adhesion in the circumference, bleeding stopped at present, and progress was observed.
Bronchoscopy photograph :
He left the hospital because the patient's amount of blood phlegm was improved gradually and the chest X-ray photograph views were improved, too.
bronchoscopy

Comment :
Though it thinks about various diseases as a cause of the hemoptysis,
it is here, and it is diagnosed as spontaneous pulmonary bleeding that
a cause isn't clear, either, in this case.
This time, a patient during seeing a doctor regularly caused hemoptysis
by the high blood pressure, and unusual views were recognized with
the chest X-ray, the chest CT, and the decline of the blood gas
oxygen pressure was recognized, too.
Rising up lesion of the half-globular form was recognized in the left
part B6 entrance, and diagnosed as the bronchus aneurysm by the
third bronchoscopy inspection.

Of course, it is diagnosed from the broncoscopy views though it is not
a fixed diagnosis because a bronchus artery angiography s isn't carried out and decision can't be diagnosed from the viewpoint of pathology
as well.
Pulmonary bleeding healed this time with the intravenous drip injection
of the astringent by the progress observation though a bronchus artery stopper method, a pulmonary leaf excision method were often carried
out as a treatment by pulmonary bleeding from the bronchus aneurysm.
There are various kinds of cases in bleeding from the bronchus
aneurysm as well, and it was reported that even observation might
heal.
The disease state that is diagnosed as spontaneous pulmonary bleeding
is thought to be equivalent to this.
Bronchus inspection was done with the examining purpose of the
cause of the hemoptysis.
A diagnosis wasn't settled, and it was diagnosed as the bronchus aneurysm by the inspection of one time in the third time.
Until a diagnosis is confirmed, it thinks that it is necessary to repeat bronchus mirror inspection.