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Pulmonary puzzle
Haemoptysis with a Danish connection
  1. Abdullahi Omar Mohamud1,
  2. Dominic Fudge2,
  3. Ben G Marshall2,3,
  4. Charles Peebles4
  1. 1 Respiratory Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  2. 2 Respiratory Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  3. 3 Faculty of Medicine, University of Southampton, Southampton, UK
  4. 4 Cardiothoracic Radiology, University Hospital Southampton, Southampton, UK
  1. Correspondence to Dr Abdullahi Omar Mohamud, Respiratory Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK; abdullahi.mohamud{at}nnuh.nhs.uk

https://doi.org/10.1136/thoraxjnl-2021-218042

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    Clinical details

    A 49-year-old woman presented to our emergency department with 1 week of productive cough, small volume haemoptysis and fevers. Her previous medical history was unremarkable, except for cervical polypectomy and daily cannabis smoking.

    Her chest X-ray revealed right upper zone consolidation. The only blood abnormalities were a C-reactive protein (CRP) of 17 and white blood cell count of 20 x 109/L . She was diagnosed with a community acquired pneumonia and discharged with a course of amoxicillin. A follow up chest X-ray was arranged.

    Two days later, she called an ambulance due to significantly worsening haemoptysis, estimated as 200 mL. On reattendance, she was cardiovascularly stable, with an increasing CRP of 74, moderate frank haemoptysis and stable haemoglobin. There was no significant respiratory compromise and she did not require transfusion or reversal of coagulopathy. She was treated with intravenous coamoxiclav,azithromycin and tranexamic acid.

    A CT chest was arranged with a working diagnosis of thoracic malignancy and superadded infection. The escalation plan in the event of large volume haemoptysis was consideration of embolisation …

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    Footnotes

    • Twitter @BenMarshall15

    • Contributors AOM made substantial contributions to the work by writing the initial draft and the subsequent draft of the work. He also worked in the construction of the puzzle, outlines a layout and sought expertise input to ensure the accuracy and validity of the work. He gave the final approval of the version to be published. He is in agreement to be accountable for all aspects of the work ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. DF made substantial contributions to the conception of the work. He worked on providing revisions to the manuscript that were important to the construction of the puzzle and provided vital input and final approval of the published work. He is in agreement to be accountable for all aspects of the work ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. BGM made substantial contributions to the design of the work. He provided expertise on tuberculosis and provided insight into the patient the puzzle is based on as her primary respiratory physician. He critically revised the work a number of times and and gave approval for the final version to be published. He is in agreement to be accountable for all aspects of the work ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CP made substantial contribution to the acquisition and interpretation of the scans in the manuscripts. He worked in the drafting and revision of the work by providing expert radiological interoperation of the scans that were originally reported by him, in the context of this manuscript. He gave final approval of the version to be published. He is in agreement to be accountable for all aspects of the work ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.