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Hemostatic forceps using soft cos di can be used with jaws closed or open. They are particularly useful for removing clots. Soft coag lets you pluck the clot while simultaneously sealing what is underneath it—the forceps provide traction while the electrical energy concentrates at the tissue interface rather than...

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✅ CT Reveal – Teaching Case CT pulmonary angiography – Lung and soft-tissue windows In this 22-year-old male with acute hemoptysis and hemoglobin drop, CT shows: ✔ Focal pulmonary hemorrhage involving the right middle and lower lobes. ✔ Expansion of the bronchus intermedius filled with an endobronchial soft-tissue lesion. ✔ Hemorrhage is downstream to the obstructed bronchus, explaining the lobar distribution seen on chest X-ray. 🎥 Lung and mediastinal window clips demonstrate the airway abnormality clearly. This confirms that the bleeding source is airway-related, not primary parenchymal or pulmonary arterial disease. ⸻ ✅ Bronchoscopy and Final Diagnosis Bronchoscopy revealed a large intrabronchial blood clot, and the patient was referred to thoracic surgery with the diagnosis of: 👉 Bronchial Dieulafoy disease. ⸻ ✅ What is Bronchial Dieulafoy Disease? Bronchial Dieulafoy disease is a rare vascular anomaly of the bronchial wall characterized by: •A dilated, tortuous submucosal artery that protrudes into the bronchial lumen. •Normal surrounding mucosa until rupture occurs. •Sudden, often massive hemoptysis, usually in young or middle-aged patients. •CT may show only indirect signs (endobronchial filling, clot, focal hemorrhage), while bronchoscopy and angiography are key for diagnosis and treatment. 📌 Biopsy is dangerous because it can trigger catastrophic bleeding. 📌 Management includes bronchial artery embolization or surgical resection when needed. ⸻ ✅ Teaching Points ✔ Always differentiate focal versus diffuse pulmonary hemorrhage. ✔ Focal, lobar hemorrhage should prompt careful evaluation of the airways. ✔ CT angiography must be reviewed in both lung and mediastinal windows, tracking the bronchi. ✔ Rare entities like Bronchial Dieulafoy disease can mimic tumors or mucus plugs on CT.

Dr Khaled Ahmed Abuzeid

11,889 Aufrufe • vor 7 Monaten