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.