CLINICAL CASE OF RIGHT LUNG ANGIODYSPLASIA WITH RECURRENT PULMONARY BLEEDING

Background. Massive pulmonary hemorrhage (grade IIIA-IVB according to the classification of Grigoriev) is a difficult problem for both ambulance teams and specialized hospitals. The mortality rates 50 % or more. Death at the top of hemorrhagic attack follows mainly from flooding of the respiratory tract with blood and asphyxia. Malformation of the lung bloodstream (angiodysplasia, angiomatosis) as the cause of pulmonary hemorrhage is a real challenge for treatment because of multiple sources of bleeding. Effective endovascular hemostasis and prevention of recurrent pulmonary hemorrhage are possible, provided that all blood vessels supplying the pathological area are occluded.

Case description. The article presents a case report of recurrent massive pulmonary hemorrhage that debuted in a 40-year-old woman with no previous pulmonary history. Inpatient treatment included tracheobronchoscopy, bronchial occlusion of the bleeding lung, obstruction of the contralateral bronchial tree, X-ray endovascular occlusion of the bronchial arteries. Pulmonary hemorrhage recurred. Repeated occlusion of the systemic lung arteries arrested the bleeding for a period. Results. Induced emergency pneumonectomy was performed at the height of recurrent pulmonary hemorrhage. Death occurred on the 6th postoperative day because of advancing nosocomial pneumonia.

Conclusion. The above case report demonstrates the difficulties of managing massive pulmonary hemorrhage in rare lung vascular malformations and multiple sources of bleeding. Occlusion of the lower diaphragmatic artery, one of the major bleeding arterial collectors, failed, which caused asphyxiating hemorrhage. Surgically successful emergency pneumonectomy resulted in death due to nosocomial pneumonia of a single lung.

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