Based on the patient’s complains (sudden worsening dyspnea and
hemoptysis) and wells diagnostic criteria for pulmonary thromboembolism
(PTE), the patient’s score was 5.5 points (3 points for no alternative
diagnosis more likely than PTE, 1.5 points for heart rate
intermediate risk for PTE. The patient underwent lung computed
tomography angiography (LCTA) and the result demonstrated that there
were no signs of PTE (Figure 1).
Figure 1. Lung computed tomography angiography (LCTA) revealed no sign
of PTE.
After ruling out PTE, the non-contrast images from the LCTA were
carefully reviewed. Based on the patient’s risk factors (smoking and
age), these images were further evaluated for potential lung pathology.
The results demonstrated some bilateral consolidations and
bronchiectasis which are shown in figure 2. So, with the diagnosis of
bacterial pneumonia, intravenous normal saline and empirical treatment
with ampoule ceftriaxone 1 gr every 12 hours and ampoule clindamycin 900
mg every 8 hours were administered.
Figure 2. The non-contrast images from the LCTA. Mild pleural effusion
with adjacent lung collapse is seen in LCTA. Collapse consolidation is
seen in left lower lobe. Mild pericardiac bronchiectasis is also seen.
After an initial three-day period of therapeutic intervention, the
patient’s fever persisted without significant reduction. Additionally,
there was a concerning escalation in the severity of hemoptysis,
surpassing the previously observed levels. Consequently, a clinical
decision was made to proceed with a bronchoscopy procedure to further
investigate and assess the underlying pathology. The bronchoscopy was
done on the day 4 of the patient’s hospitalization and the diagnosis was
made.