Retrospective surgical and autopsy case series (1979–2018) of 16 patients with pathologically localizable bleeding sources in severe hemoptysis associated with cavitary lung disease, using serial histological sections to identify ruptured vessels and vascular mechanisms.
Pulmonary arterial lesions were the dominant source: 14 of 16 cases had pulmonary arterial bleeding (13 pseudoaneurysms, 1 direct rupture); systemic arterial bleeding accounted for 2 cases. Systemic-pulmonary arterial shunts were present in 11 of 14 pulmonary arterial bleeding cases (9 confirmed histologically, 2 by angiography). No pulmonary venous bleeding was found.
Very small, highly selected cohort (n=16) limited to cases with pathologically localizable sources, excluding 6 cases without definitive localization; long retrospective span (1979–2018) introduces variability in diagnostic practices; findings may not generalize to broader or medically managed hemoptysis populations.
In severe cavitary hemoptysis, pulmonary artery pseudoaneurysms and systemic-pulmonary arterial shunts — not bronchial or venous sources — appear to dominate in surgically/pathologically confirmed cases; clinicians should consider pulmonary arterial evaluation alongside standard bronchial artery workup. However, prevalence in broader populations remains unknown and warrants further study.
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