A Rare Case of Hemoptysis in a Pediatric Patient Leading To Lobectomy

Introduction Hemoptysis is rare in children unless the bleeding is substantial. Young children tend to swallow their sputum, making diagnosis challenging. When evaluating a child with blood excretion, it's crucial to determine whether the bleeding originates from the lungs, the upper airway or gastrointestinal system [1]. Case Presentation A 9 y/o boy with multiple health issues (cerebral palsy, epilepsy) was hospitalised due to cough, fever and decreased apetite. On 7th day of hospitalization his condition worsened with severe coughing fits and coughing up blood. Patient received treatment at pediatric intensive care unit (PICU) for 10 days owing to destructive pneumonia and pulmonary bleeding resulting in respiratory failure. Patient's condition required intubation and mechanical ventilation as respiratory failure advanced. Bronchoscopy revealed bleeding from the right upper segmental bronchus. Tranexamic acid was administered, proving effective initially, but the bleeding recurred. Subsequent CT angiography identified active extravasation from necrotic areas in the lungs, leading to angiography embolization, successfully preventing further bleeding. After a week in the PICU, the patient was extubated, but began coughing up blood and desaturated the same day. CT images indicated extensive inflammation with pronounced tissue death and hollow spaces, with evidence of active bleeding. Patient presented with symptoms of paleness, palpable central pulse, saturation - 64%, a heart rate - 150bpm, cold extremities and aspiration of significant fresh blood through the intubation tube. After consultation, the patient was emergently prepared for a thoracotomy and resection of the upper lobe of the right lung. Patient underwent gastrostomy tube placement surgery, pneumonia has not recurred. Discussion Considering our patient's comorbidities - hemoptysis was most likely attributed to an aspirated foreign body that caused aspirated pneumonia, abscess that ruptured and caused hemoptysis. Scant hemoptysis usually resolves spontaneously and is unlikely to recur [2]. Conclusions Hemoptysis is categorized into scant (< 5mL), moderate (6-240 mL) and massive (>240 mL) [3]. Hemoptysis is rare in children and usually caused by a harmless condition that resolves on its own. A thorough medical history and physical exam are essential to assess the severity [2].