Hemoptysis secondary to pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation: A case report and literature review

ObjectivesPulmonary vein stenosis (PVS) is a known complication after radiofrequency ablation of atrial fibrillation (RAAF) and is often misdiagnosed owing to lack of awareness regarding PVS among noncardiologists. Misdiagnosis results in unnecessary treatment; therefore, greater understanding of PVS can improve the management of these patients.MethodsWe report the case of a 38-year-old man with a history of RAAF who presented with massive hemoptysis. His symptoms persisted despite undergoing transcatheter bronchial artery embolization on two occasions.ResultsPulmonary computed tomography angiography revealed a completely occluded left superior pulmonary vein. Considering the patient’s history of RAAF, we diagnosed him with RAAF-induced PVS and performed left superior lobectomy after which hemoptysis did not recur.ConclusionsUnexplained massive hemoptysis should alert clinicians regarding the possibility of RAAF-induced PVS. Balloon angioplasty and stent placement are used to treat PVS; however, their efficacy is controversial considering the high recurrence rates associated with these interventions.     

Patient and Procedure-related Characteristics Correlated With Severity of Hemoptysis Following Percutaneous Transthoracic Needle Biopsy: Results of a 10-year Retrospective Review

PurposeA risk of percutaneous transthoracic needle biopsy (PTNB) is hemoptysis, which can range from mild to life-threatening. The reported occurrence of hemoptysis is 1.7% to 14.5%, and the demographic, patient, and procedure characteristics have not been extensively described. The purpose of this study was to assess the associations of demographic, patient, and procedure characteristics with the severity of hemoptysis.Materials and MethodsA single institution, single group, retrospective, electronic medical record (EMR) review was performed on all hemoptysis events occurring between 2008 and 2018. Demographic, clinical, and procedure variables were extracted from EMRs. Outcome of hemoptysis events was graded using Common Terminology Criteria for Adverse Events (CTCAE). Mild-moderate and severe hemoptysis were defined as CTCAE classifications of 1-2 and 3-5, respectively. Associations were generated using logistic regressions and Likelihood Ratio Chi-Square tests.ResultsIn 10 years, 14,665 PTNB resulted in 231 hemoptysis events occurring in 229 patients; 12.7% (n = 29) of those were severe. The strongest and statistically significant variables associated with an increased likelihood of a severe event, if an event occurred, were cigarette pack years (OR = 1.02, 95% C.I. = 1.01-1.04, p = .020); history of chronic obstructive pulmonary disease (COPD) (OR = 3.68, 95% C.I. = 1.53-8.82, p = .003); core biopsy technique (OR = 8.13, 95% CI = 1.07, 61.40, p = .042), and larger diameter needle (20 g vs. 18 g: OR = 2.60, 95% CI 1.09, 6.17, p = .031).ConclusionsPTNB-associated hemoptysis was an uncommon event that was rarely life-threatening. The extent of the patient’s smoking history, the diagnosis of COPD, and core biopsy technique were associated with an increased likelihood of severe hemoptysis.