Tuberc Respir Dis.  2012 Dec;73(6):325-330. 10.4046/trd.2012.73.6.325.

A Case of Radiation Bronchitis Induced Massive Hemoptysis after High-Dose-Rate Endobronchial Brachytherapy

• Lee SJ
• Lee JY
• Jung SH
• Lee SN
• Lee JH
• Kim CW
• Jung S
• Jung YR
• Lee WY

• KMID: 1842926
• DOI: http://doi.org/10.4046/trd.2012.73.6.325

Abstract

High-dose-rate endobronchial brachytherapy (HDREB) have been used as the treatment of early endobronchial cancer, as well as for palliation of advanced cancer. However, fatal hemoptysis can occur after HDREB at the rate of 7~32%. We report a case of massive hemoptysis due to radiation bronchitis developed after HDREB. A 67-year-old man was treated with HDREB for early endobronchial cancer on the left upper lobe bronchus. He complained of persistent cough from 4 weeks after completion of HDREB. Radiation bronchitis was observed on the bronchoscopy at 34 weeks, and it was progressed from mucosal swelling and exudate formation to necrosis and ulceration without local relapse. In addition, he died of massive hemoptysis after 15 months. The patient had no sign or radiologic evidences to predict the hemoptysis. This case implies that HDREB directly contributes to an occurrence of a fatal hemoptysis, and follow-up bronchoscopy is important to predict a progression of radiation bronchitis and fatal hemoptysis.

Keyword

Radiation; Bronchitis; Hemoptysis; Brachytherapy

MeSH Terms

Brachytherapy
Bronchi
Bronchitis
Bronchoscopy
Cough
Exudates and Transudates
Follow-Up Studies
Hemoptysis
Humans
Necrosis
Recurrence
Ulcer

Figure

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  Figure 1 Chest X-ray. Chest poteroanterior (A) and right decubitus view (B) show right pleural effusion.

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  Figure 2 Chest computed tomography scans. Chest computed tomography scans show consolidation in right lower lobe and right pleural effusion (A) but, there is no evidence of tumor or endobronchial lesion in left bronchial tree (B).

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  Figure 3 Bronchoscopic and pathologic findings at initial visit. Bronchoscopic finding shows irregular mucosal surface of proximal left upper lobe bronchus (A). Pathologic diagnosis is squamous cell carcinoma (B) (H&E stain, ×100).

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  Figure 4 Bronchoscopic findings following high-dose-rate endobronchial brachytherapy. Radiation bronchitis was detected in left upper lobe bronchus at 34 weeks (A, arrow) and in left mainstem bronchus at 50 weeks after last brachytherapy (D, arrowhead). Bronchoscopic findings show mucosal edema and fibrosis. The bronchitis progressed to necrosis and ulceration at 54 weeks after brachytherapy (B, E). The necrosis and ulceration became larger and deeper despite a treatment of oral corticosteroids (C, F).

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