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 Table of Contents  
Year : 2023  |  Volume : 6  |  Issue : 1  |  Page : 32-33

Bronchoscopy Quiz

Department of Pulmonology, Apollo Hospitals, Chennai, Tamil Nadu, India

Date of Submission23-Jan-2023
Date of Decision22-Feb-2023
Date of Acceptance03-Apr-2023
Date of Web Publication29-Apr-2023

Correspondence Address:
Dr. A Vasudevan
Department of Pulmonology, Apollo Hospitals, Greams Road, Chennai - 600 006, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/japt.japt_2_23

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How to cite this article:
Vasudevan A, Narasimhan R. Bronchoscopy Quiz. J Assoc Pulmonologist Tamilnadu 2023;6:32-3

How to cite this URL:
Vasudevan A, Narasimhan R. Bronchoscopy Quiz. J Assoc Pulmonologist Tamilnadu [serial online] 2023 [cited 2023 May 29];6:32-3. Available from: https://www.japt.in//text.asp?2023/6/1/32/375457

  Bronchoscopy Quiz Top

A 50-year-old female, with no known comorbidity presented to the outpatient department with complaints of persistent cough for 3 months and history of hemoptysis of 3 episodes of about 3–5 ml/episode. There was no history of fever, weight loss, or trauma. She was hemodynamically stable with a saturation of 97% on room air.

Chest X-ray and contrast-enhanced computed tomography (CECT) of the chest of this patient were unremarkable. Her coagulation profile was also normal. No prior history of tuberculosis was noted. Hence, a diagnostic bronchoscopy procedure was planned. [Figure 1]a and [Figure 1]b shows the bronchoscopic findings of this patient.
Figure 1: (a and b) Endobronchial telangiectactic leisions

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  Questions Top

  1. Identify this lesion?
  2. Enumerate the differential diagnosis of this lesion?
  3. What are the conditions associated with this lesion?

  Answers Top

  1. This bronchoscopy image depicts multiple telangiectasia which is referred as “Endobronchial Telangiectasia”
  2. Differential diagnosis of this lesion is “Haemorrhagic bronchial mucosa syndrome”
  3. This endobronchial telangiectasia is usually associated with scleroderma, CREST (C-calcinosis, R-raynaud's phenomenon, E-esophageal dysmotility S-scelerodactyly T-telengiectasias) syndrome, and hereditary hemorrhagic telangiectasia.

  Discussion Top

The most common cause of hemoptysis is infections and malignancy, although various other pulmonary and systemic conditions can also be the cause.[1]

Endobronchial telangiectasia can also be a cause of hemoptysis in certain patients. This condition is associated with scleroderma, hereditary hemorrhagic telangiectasia, cirrhosis, or as an isolated condition.[2]

Limited scleroderma usually presents as calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST syndrome).

Hereditary hemorrhagic telangiectasia is an autosomal dominant vascular disorder associated with the formation of small arteriovenous malformations in multiple organs including the lungs.

Endobronchial vascular lesions are seen in patients with cirrhosis along with esophageal varices.[3] Isolated endobronchial telangiectasia is quite rare.

These vascular lesions can also lead to massive hemoptysis.

  Diagnosis Top

As in this case, CECT chest of the patient will be normal in these lesions, and hence, bronchoscopy plays a major role in diagnosing this condition.

  Treatment Top

Most causes are self-limiting and do not warrant any aggressive investigation. The treatment options include coagulation of the lesion or angioembolization in case of large lesions if a feeding vessel is identified. Surgical resection is reserved for larger lesions not amenable to endovascular or bronchoscopic modalities. Electrocoagulation or argon plasma coagulation is the main therapeutic modalities for the management of superficial telangiectasias.

Argon plasma coagulation is safer than electrocoagulation as it has less risk of perforation or cartilage damage and better control of depth.[4]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.


We would like to thank the Department of Pulmonology, Apollo Hospitals, Chennai, Tamil Nadu, India.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Rudrappa M, Kokatnur L. Diffuse endobronchial telangiectasia. Int J Appl Basic Med Res 2020;10:137-9.  Back to cited text no. 1
Andrea Hana SL, Alain T. Endobronchial telangiectasias. J Bronchol 2006;13:210-1.  Back to cited text no. 2
Youssef AI, Escalante-Glorsky S, Bonnet RB, Chen YK. Hemoptysis secondary to bronchial varices associated with alcoholic liver cirrhosis and portal hypertension. Am J Gastroenterol 1994;89:1562-3.  Back to cited text no. 3
Madan K, Dhungana A, Hadda V, Mohan A, Guleria R. Flexible bronchoscopic argon plasma coagulation for management of massive hemoptysis in bronchial Dieulafoy's disease. Lung India 2017;34:99-101.  Back to cited text no. 4
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