HEMOPTYSIS FROM AN EMPHYSEMATOUS BULLA DEVELOPING AFTER OPEN-HEART-SURGERY - REPORT OF A CASE

We present herein the case of a 62-year-old woman with an emphysematou s bulla who developed intractable hemoptysis 16 days after undergoing mitral and aortic valve replacement with tricuspid annuloplasty. A bro nchoscopic examination with balloon occlusion of the bronchial lumen r evealed that the blood source was the right middle lobe bronchus. A co mputed tomographic (CT) scan of the chest subsequently demonstrated a blood-filled emphysematous bulla in the right middle lobe. A right mid dle lobectomy was performed and the bulla was observed to be swollen w ith clotted blood. The respiratory tract bleeding stopped immediately after the lobectomy. Pathohistological examinations suggested that dis ruption of the pulmonary vessels in the wall of the bulla had caused t he respiratory tract bleeding.