Dieulafoy’s disease with mediastinal arteriovenous malformation

A 42-year-old, non-smoker man was hospitalised for newly diagnosed acute myeloid leukaemia and had an episode of haemoptysis of 200 mL fresh blood, complicated by transient hypotension. Patient was afebrile and his blood results were: haemoglobin 10.0 g/dL decreasing to 8.5 g/dL within 1 day of haemoptysis, total white cell counts 23x109/L, platelet counts 30x109/L, normal renal panel and coagulation profile. CT scan reported extensive tortuous mediastinal vessels (figure 1A). Flexible bronchoscopy under platelet transfusion revealed a small lesion in the right upper lobe (RUL) bronchus (figure 2). Upon contact of the bronchoscope tip with the lesion, brisk bleeding occurred (online supplementary video) which ceased with ice-cold saline wash. A diagnosis of Dieulafoy’s disease associated with mediastinal arteriovenous malformation (AVM) was made. CT angiogram followed by embolisation of major vessels feeding into RUL (figures 1B …