Chest CT results showed consolidation and ground-glass opacities in the middle and lower lobes of the right lung. Given the widespread lung damage and initial sputum AFB tests for tuberculosis screening being negative, Dr. Nguyen Thanh Thuy, a Level I Specialist and Master of Science in the General Internal Medicine Department at Tam Anh General Hospital, TP HCM, prescribed hemostatic treatment, antibiotics, and bronchoscopy.

The bronchoscopy revealed numerous blood clots obstructing the bronchial branches of the right lung's middle and lower lobes. The medical team performed bronchial lavage and suctioned out the blood clots to clear the airway, preventing lung collapse and respiratory failure. Specimens were sent for molecular biology testing, bacterial culture, and tuberculosis culture.

Following the bronchoscopy, Linh's condition stabilized; she breathed easily and no longer coughed up blood. On the 4th day, she resumed coughing up a small amount of blood, approximately 5 ml (compared to about 2 ml previously), accompanied by a decrease in blood oxygen saturation (SpO2) to just 89%, whereas normal levels are above 95%.

Dr. Thuy stated that severe hemoptysis progressing to respiratory failure is extremely dangerous. The team performed bronchial artery embolization using a digital subtraction angiography (DSA) system for emergency hemostasis. This technique involves inserting a catheter into the blood vessels supplying the affected area and then using specialized materials to block the bleeding bronchial artery branch.

The team performing bronchial artery embolization for emergency hemostasis. *Photo: Tam Anh General Hospital*

Following the intervention, the respiratory failure rapidly improved, the patient no longer coughed up blood, and blood oxygen saturation stabilized. Molecular biology - line probe assay (LPA) results from the bronchial lavage fluid tested positive for tuberculosis bacteria and showed no resistance to anti-tuberculosis drugs. Doctors identified pulmonary tuberculosis as the cause of the hemoptysis and initiated an outpatient anti-tuberculosis treatment regimen.

According to Dr. Thuy, many cases of pulmonary tuberculosis do not present with prolonged cough, fever, or weight loss, but instead begin with hemoptysis. Furthermore, an initial negative AFB test does not completely rule out tuberculosis. In highly suspected cases, patients may require additional diagnostic procedures such as bronchoscopy, molecular biology testing, and specialized cultures for diagnosis.

Doctors recommend that individuals experiencing hemoptysis seek early medical evaluation. This could be a symptom of several serious respiratory conditions, including pulmonary tuberculosis, bronchiectasis, necrotizing pneumonia, or lung cancer.

Nhat Thanh

*Patient's name has been changed