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Haemoptysis in PAH — EECC MCQ

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ModeratePulmonary Vascular DiseaseHaemoptysis in PAHEECC

A 50-year-old man with known PAH (WHO FC III on dual oral therapy) develops new onset haemoptysis. His CT pulmonary angiogram shows dilated bronchial arteries. What is the cause and management?

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Correct answer: B — Haemoptysis in PAH results from rupture of hypertrophied bronchial arteries (which develop as collateral blood supply in response to reduced pulmonary arterial flow) or from pulmonary artery aneurysm rupture — management includes bronchial artery embolisation for significant bleeding

Haemoptysis in PAH occurs in 10-20% of patients and can be life-threatening. Mechanisms: (1) bronchial artery hypertrophy and rupture — in PAH, reduced pulmonary arterial flow triggers compensatory bronchial artery enlargement (systemic-to-pulmonary collaterals); these high-pressure systemic arteries can rupture into the airway; (2) pulmonary artery aneurysm (PA main/branch dilatation from chronic PH) with erosion into adjacent airway; (3) in situ thrombosis causing pulmonary infarction. Management per ESC/ERS 2022 PH Guidelines: (1) stabilise (airway, O₂, lateral decubitus with bleeding side down); (2) CT angiography to identify source; (3) bronchial artery embolisation (BAE) — the primary intervention for significant haemoptysis from bronchial artery source (>90% initial success); (4) withhold/reduce anticoagulation during active bleeding; (5) escalate PAH-specific therapy to reduce PA pressures; (6) surgical resection rarely needed.

Reference: ESC/ERS (2022): PH Guidelines