An 11-year-old girl was admitted to Chengdu Women and Children's Central Hospital due to an 8-month history of cough and 2 episodes of mild to moderate hemoptysis (100-200 mL of blood loss over 24 hours). Her cough was occasional and dry at first, but later it became more frequent and productive, without fever, chest pain, wheezing, or dyspnea. She received a 7-day course of amoxicillin and clavulanate potassium for pulmonary infection in a local hospital. Unfortunately, she responded poorly to the treatment. The second episode of hemoptysis had occurred 2 days before admission to our hospital, after which she was referred to us for treatment.
It is noteworthy that the girl had been full-term at birth, healthy, and without tuberculosis or measles.
At the time of admission, the patient was not febrile, and had a respiratory rate of 21 breaths/min, heart rate of 90 beats/min, blood pressure of 101/71 mmHg, and oxygen saturation of 98% in ambient air. The breath sounds were harsh and neither rales nor wheezing were heard. The results of other physical examinations were unremarkable.
The white blood cell count was 6.79 x 109/mL, with 69.7% neutrophils, and the hemoglobin level and platelet count were 116 g/L and 381 x 109/mL, respectively. The results of biochemical tests were normal. Tuberculin skin test (TST) was negative.
Serum test for anti-mycoplasma pneumoniae antibodies yielded positive results, with a titer of 1:160. Other pathogens including common respiratory viruses and tuberculosis bacteria were not found.
Chest computed tomography revealed pneumonia and a lung abscess was suspected in the lower lobe of the left lung (Fig. 1). Pulmonary contrast-enhanced CT revealed a dense, cuneate shadow in the left lower lobe with a multiple-capsule shape, and the left lower lobe bronchus was significantly narrow. These were speculated to be congenital malformations (Fig. 2A and B).
Subsequently, the patient underwent bronchoscopy. The diameter of the left bronchus was found to be reduced and a previous pulmonary hemorrhage was observed (Fig. 3). The patient then underwent surgical resection of the left lower pulmonary lobe. Gross pathologic examination of the lung tissue revealed dilation of the bronchia and blood vessels (Fig. 4A and B).
In a part of the lung tissue, the bronchia and alveoli were stunted and bronchiectasic. Chronic inflammation of the bronchia had invaded the alveoli with acute episodes, and some of the alveoli were fractured and fused. Hemorrhage and fibrinoid exudation were observed on the pathologic slice (Fig. 5A and B).
The girl recovered favorably after the operation, without any complications. The hemoptysis was controlled and the cough disappeared after surgery. At a follow-up visit in January 2018, we performed a chest x-ray examination, and the results were normal (Fig. 6).