Haemoptysis in a Patient with COPD Due to Right Bronchial Artery Dilation.

Introduction: Haemoptysis is a potentially life-threatening symptom, particularly in patients with chronic pulmonary diseases, where identifying the exact source of bleeding can be challenging. Case description: We present the case of a 76-year-old woman with a history of chronic obstructive pulmonary disease and bronchiectasis, who experienced recurrent episodes of haemoptysis. Initial investigations, including imaging and infectious work-up, were inconclusive. While a CT pulmonary angiography excluded a pulmonary embolism, a subsequent CT aortogram revealed a contrast-filled outpouching in the right lower lobe, raising suspicion of a right basal pseudoaneurysm. Digital subtraction angiography confirmed a markedly dilated right bronchial artery with active contrast extravasation. The patient underwent successful endovascular embolization using coils and microparticles, resulting in complete resolution of haemoptysis and clinical stabilisation. The resolution of symptoms confirmed the dilated right bronchial artery as the source of bleeding, consistent with angiographic findings. Conclusion: This case emphasises the importance of considering atypical vascular causes, such as bronchial artery dilation, in patients with haemoptysis and underlying chronic inflammatory lung conditions. Early recognition and targeted intervention are critical for effective management and prevention of serious complications. LEARNING POINTS: Vascular causes of haemoptysis, though often overlooked, should be included in the differential diagnosis for patients with chronic lung disease such as COPD and bronchiectasis.Digital subtraction angiography played a key role in mapping the source of bleeding, serving both diagnostic and therapeutic purposes.This case highlights the importance for internists of early recognition and intervention of haemoptysis from uncommon sources to prevent potential complications.