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Cardiovascular Images
December 16, 2020

A Patient in Their 40s With Intermittent Hemoptysis

Author Affiliations
  • 1Echocardiography Fellowship, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
  • 2Echocardiography Department, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
JAMA Cardiol. 2020;5(12):e206523. doi:10.1001/jamacardio.2020.6523

What is the differential diagnosis of the finding noted in the descending aorta in a patient with hemoptysis? A patient in their 40s with a 6-month history of intermittent hemoptysis and anemia presented to the emergency department with new-onset dyspnea and massive hemoptysis. The patient had a remote history of cocaine use and recent negative test results for HIV and tuberculosis. On admission, an electrocardiogram showed sinus tachycardia. The patient’s hemoglobin level was 8 g/dL (to convert to grams per liter, multiply by 10). A transthoracic echocardiogram was performed. An unusual echodensity was noted in the descending aorta; an ultrasonic-enhancing agent was given for better visualization (Figure, A; Video). A contrast chest computed tomography scan was then performed. An aortic pseudoaneurysm with an aortobronchial fistula was evident (Figure, B and C). A Medtronic Valiant Captiva stent graft 157 mm × 32/32 mm in size was placed satisfactorily. The patient was discharged without complications and continues to receive follow-up care in the outpatient clinic.1,2

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