A 36-year-old man was admitted to intensive care unit with acute exacerbation of chronic heart failure. His clinical history included IC with 20 % ejection fraction , aortic valvar replacement with bioprosthesis for aortic stenosis, endovascular stent implant for aortic aneurysm and permanent step-mark placement due to a full AV heart block. A ventricular assistance device was placed for the treatment of acute Cl, and a continuous infusion of heparin was initiated for systemic anticoagulation. During the following week, the patient presented with episodes of small volume hemoptysis, respiratory discomfort and becoming dependent on the use of supplementary oxygen (up to 20 litres administered through a high flux nasal cannula). ๐๐ฎ๐ซ๐ข๐ง๐ ๐๐ง ๐๐ฑ๐ญ๐ซ๐๐บ๐ ๐๐ผ๐ฎ๐ ๐ก ๐๐ซ๐ข๐ฌ๐ข๐ฌ, ๐ญ๐ก๐ ๐ฉ๐๐ญ๐ข๐๐ง๐ญ ๐ฌ๐ฉ๐ผ๐ง๐ญ๐๐ง๐๐ผ๐ฎ๐ฌ๐ฅ๐ฒ ๐๐ง๐ญ๐ข๐๐ข๐ฉ๐๐ญ๐๐ ๐๐ง ๐ข๐ง๐ญ๐๐๐ญ ๐บ๐ผ๐ฅ๐ ๐ผ๐ ๐ญ๐ก๐ ๐ซ๐ข๐ ๐ก๐ญ ๐๐ซ๐ผ๐ง๐๐ก๐ข๐๐ฅ ๐ญ๐ซ๐๐. The right bronchial tree consists of three segmentary branches in the upper wolf (blue arrows), two segmentary branches in the middle wolf (white arrows) and five segmentary branches in the lower wolf (black arrows). The patient's trachea was subsequently intubated and flexible bronchoscopy revealed a small amount of blood in the basic branches of the lower right wolf. Patient was extubated 2 days later and had no more episodes of hemoptysis. One week after extubation, he died of complications from heart failure (volume overload and impaired heart rate) despite the placement of the ventricular assistance device. Credit: The New england journal of medicine #clinical #cases #medicine #pulmonology #heart #cardiology #surgery #hearthealth #hospital #science #medicogram
