A 57-year-old gentleman with a history of aortic valve replacement on chronic Coumadin as well as history of pulmonary tuberculosis who presented to the hospital after coughing up copious amounts of blood for 2 days. His international normalized ratio was supratherapeutic at 3.3, but the rest of his admission laboratory work was otherwise unremarkable. A CT scan revealed significant bilateral upper lobe emphysematous changes as well as right upper lobe bronchiectasis (Fig. 1).
The patient was brought urgently to the bronchoscopy suite. FOB revealed significant bleeding from the apical segment of the right upper lobe. The airways were aggressively suctioned, and an embolism coil was initially placed in the subsegment to slow the bleeding. This was followed by ORC placement as described above. Another coil was then placed to secure the ORC. There was no evidence of active bleeding, and the patient was able to be brought safely to the ICU and later discharged. As of the writing of this manuscript, there have been no further complaints of hemoptysis.