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A7048 - Hemoptysis 38 Years After Radiation Therapy for Hodgkin'S Lymphoma: A Rare but Serious Complication
Author Block: A. Minami1, M. Mowafy1, S. Al-Adwan1, T. Minami2; 1Internal Medicine, Memorial Hospital of Rhode Island, Pawtucket, RI, United States, 2Pulmonary, Critical Care and Sleep Medicine, Memorial Hospital of Rhode Island, Pawtucket, RI, United States.
Introduction: Over the last four decades, significant advance in the treatment has been continuously improving long-term survival of patients with Hodgkin lymphoma (HL). With increased number of long-term HL survivors, it has been recognized that those patients are at high risk of the life-threatening late complications such as second malignancy and cardiovascular disease. We present a rare case of long-term HL survivor who presented with hemoptysis, which was later determined as a late complication of radiotherapy.Case presentation: A 53-year- old woman with HL treated with chemotherapy and radiotherapy 38 years prior to this event was admitted to the hospital because of hemoptysis for one day. She complained of hemoptysis of reportedly significant degree of amount. In the emergency department, she was noted to have coughed up bright red blood with clots. Computed tomography angiogram of the chest showed no specific abnormalities in lung parenchyma. She was admitted to the hospital for the further management. On examination, she was not in respiratory distress. The temperature was 36.6 C, the blood pressure 154/94 mmHg, the pulse 85 beats per minute and the respiratory rate 19 breaths per minute, oxygensaturation 96% with ambient air. Auscultation of the chest revealed diffuse rhonchi bilaterally.Laboratory findings include hemoglobin 13.0 g/dL. Flexible bronchoscopy on day 2 revealed no endotracheal tumor or evidence of endotracheal bleeding, although it revealed diffuse bronchitis and bleeding was considered to come from left upper lung. Empiric treatment with methylprednisolone was started for possible alveolar hemorrhage. The patient continued to have hemoptysis and pulmonary angiogram was performed on day 12, which revealed very small left bronchial artery and hypervasculatiry of the area. A bronchial artery embolization was performed. The symptoms improved and she was discharged on day 17.Discussion: As HL has become a curable disease, those patients are at higher risk of late complications. It was reported that patients treated with high dose of radiotherapy especially of mantle field irradiation have higher risk of delayed complications than those who were treated with limited irradiation. Given unusual anatomical finding on pulmonary angiogram of this patient, her symptom was thought to be a late complication of radiotherapy.Presumably radiation-induced inflammation and fibrosis of brachial artery led to reformation of vascular structure and eventually resulted in bleeding from this area.Conclusion: This case highlights the importance of recognizing this extremely rare but important complication of radiotherapy, particularly when it was performed long time ago as in this case.