A 49-year-old woman was admitted to our hospital complaining of haemoptysis for 6 days on August 14, 2018. She began experiencing intermittent haemoptysis accompanied by cough and itch after lunch on August 8, 2018. She claimed no chest pain and was breathless. Oral haemostatic medicine showed few therapeutic effects. Chest CT showed infection and diffusely scattered nodules in both lungs (Figure 1). She had no medical history other than hyperglycaemia, and her physical examination was unremarkable. She also denied any family history of hereditary diseases or cancer. She was admitted to our department with stable vital signs diagnosed as pulmonary infection and pulmonary nodules. Differential diagnosis was performed after admission. There were no remarkable findings on the rheumatic immune system; tumour indicators were all normal; tuberculosis and fungal infections were not indicated; and no abnormalities were found in the abdominal system, urinary system, or gynaecological ultrasonography. Thyroid ultrasonography revealed a hypoechoic mass in the bilateral neck, which was considered to be the lymph node. Bronchoscopy showed bloody secretion in the bronchus in the left upper lobe. The right inferior lobe of the base was also found to be blocked by an obsolete thrombus and could be recanalised by thrombus aspiration.
The patient received anti-infection and haemostasis therapy. However, a re-examination by chest CT on August 24 showed more and larger nodules in both lungs than previously (Figure 2). Afterwards, a right lobe mass biopsy was performed under CT guidance. Pathology showed multiple nodular lesions and round or short spindle-shaped tumour cells, forming a solid nest structure. Nuclear divisions and vascular lacunar-like structures containing red blood cells were visible. Immunohistochemical analysis of these nodules revealed positive expression of vimentin, CD31, and CD34. This pathological examination confirmed the diagnosis of PEH (Figure 3).
Considering haemoptysis, she did not receive antiangiogenic treatment. Unfortunately, she experienced recurrent haemoptysis on October 2018. More exudative lesions and diffusely scattered nodules in both lungs were observed on chest CT (Figure 4). Active rescue failed, and this patient passed away 8 weeks after diagnosis.