Endobronchial lesion in an adolescent with hemoptysis biopsy or not to biopsy?

An 11-year-old girl was brought with complaints of recurrent massive hemoptysis. A computerized tomography (CT) of the chest showed ground glass opacities on the right lower lobe, and a CT angiography showed hypertrophied right pulmonary artery. Flexible bronchoscopy revealed a sessile friable lesion in the right lower lobe, raising suspicion of either a tumor or a vascular malformation. An endobronchial ultrasound (EBUS) revealed a cystic lesion in the submucous plane, with vascularity noted on Doppler mode. This confirmed the diagnosis of bronchial Dieulafoy disease. A bronchial angiography revealed a vascular malformation overlying the lesion with a bronchopulmonary shunt, which was ligated. This case demonstrates the importance of EBUS in endobronchial lesions, to avoid biopsy of a vascular malformation.

Automated summary

An 11-year-old girl presented with recurrent massive hemoptysis. Imaging studies revealed ground glass opacities and hypertrophied right pulmonary artery. Bronchoscopy and endobronchial ultrasound confirmed the diagnosis of bronchial Dieulafoy disease. Bronchial angiography showed a vascular malformation, which was successfully treated.