Bronchial Dieulafoy's disease complicated by pulmonary embolism after successful hemostasis: a case report and review of the literature.

backgroundBronchial Dieulafoy's disease (BDD) is a rare vascular anomaly characterized by a large-caliber submucosal artery that can cause sudden, massive, and potentially fatal hemoptysis. Because of its deceptively benign endobronchial appearance, the disease is frequently underrecognized and carries a high risk of catastrophic bleeding following bronchoscopic manipulation. CASE PRESENTATION: A 77-year-old woman without underlying lung disease developed massive hemoptysis and hemorrhagic shock shortly after diagnostic bronchoscopy for an indeterminate endobronchial lesion. Emergency bronchial artery embolization (BAE) achieved effective hemostasis. During recovery, pulmonary embolism was suspected and subsequently confirmed by computed tomography pulmonary angiography (CTPA); the event was classified as intermediate-risk based on right-heart strain and cardiac biomarkers, posing a major therapeutic dilemma regarding anticoagulation after recent life-threatening airway bleeding. After secure hemostasis had been confirmed by the absence of recurrent hemoptysis, stable vital signs and hemoglobin, no further transfusion requirement, and post-embolization angiographic control, anticoagulation was managed through a stepwise strategy: temporary lower-intensity low-molecular-weight heparin followed by escalation to full therapeutic anticoagulation after PE confirmation and clinical stabilization. Follow-up imaging before discharge demonstrated marked resolution of clot burden, and no recurrent hemoptysis occurred during anticoagulation.

conclusionsThis case emphasizes three practical lessons: BDD should be suspected in benign-appearing endobronchial lesions associated with unexplained hemoptysis; bronchoscopic biopsy should be avoided until a vascular lesion is reasonably excluded; and BAE can provide lifesaving hemostasis. In carefully selected patients who develop PE after secure hemostasis, stepwise anticoagulation may be considered under multidisciplinary monitoring, but this single case should be interpreted as hypothesis-generating rather than a generalizable treatment recommendation.