Emergency management of life-threatening haemoptysis due to invasive pulmonary aspergillosis in a sarcoidosis patient

Popescu F, Lutz M, Kalkat MS, Aktuerk D

Abstract

A 68-year-old male ex-smoker was admitted to the emergency department with brisk haemoptysis of approximately 2 L in 4 h. Furthermore, he described increasing breathlessness and weight loss over the past 6 weeks. In terms of previous medical history, he had sarcoidosis, immune thrombocytopenic purpura and insulindependent diabetes mellitus. An urgently performed computed tomography scan of the chest demonstrated two large soft tissue masses in the upper lobe of the left lung. The appearances were characteristic for invasive pulmonary aspergillosis including the air crescent sign (also called Monad sign). The patient underwent emergency angiography for selective bronchial artery embolization and his symptoms improved subsequently. However, the patient presented with recurrent haemoptysis 2 weeks later. Thus, he underwent left thoracotomy and upper lobectomy. Histology demonstrated aspergillomas in the background of a fibrotic granulomatous process, which is in keeping with the known lung sarcoidosis. © 2016 Royal Australasian College of Surgeons.