PMC9561465_01
Chest x-ray at the time of hemoptysis.
fcvm-09-997990-g0001.jpg
PMC9561465_01_fcvm-09-997990-g0001.jpg
F1
His chest x-ray demonstrated bilateral opacifications (Figure 1).
Bronchoscopy reveals massive hemoptysis.
fcvm-09-997990-g0002.jpg
PMC9561465_01_fcvm-09-997990-g0002.jpg
F2
Despite the evacuation of more than 500 cc of blood under bronchoscopy, there was continued hemorrhage from both main bronchi (Figure 2).
Tracheostomy tube was removed, and direct suction was performed from tracheal stoma using Yankauer catheter.
fcvm-09-997990-g0003.jpg
PMC9561465_01_fcvm-09-997990-g0003.jpg
F3
A direct suction was then attempted, inserting a Yankauer suction catheter into the trachea via the tracheostomy stoma (Figure 3).
Chest x-ray off ventilator support.
fcvm-09-997990-g0004.jpg
PMC9561465_01_fcvm-09-997990-g0004.jpg
F4
Though active hemorrhage had ceased during this time of mechanical ventilation, the patient's chest x-ray continued to exhibit bilateral opacification (Figure 4).
Chest x-ray 2 days after resuming ventilator.
fcvm-09-997990-g0005.jpg
PMC9561465_01_fcvm-09-997990-g0005.jpg
F5
This process was continued daily until all visible clot was removed and chest x-ray demonstrated decreased opacification (Figure 5).
Chest x-ray 4 days after resuming ventilator.
fcvm-09-997990-g0006.jpg
PMC9561465_01_fcvm-09-997990-g0006.jpg
F6
Over time, chest x-ray findings improved on these ventilator settings, with TV ~50cc (Figure 6).
Chest x-ray after ECMO decannulation.
fcvm-09-997990-g0007.jpg
PMC9561465_01_fcvm-09-997990-g0007.jpg
F7
With significant radiographic improvement (Figure 7), VV ECMO was successfully decannulated at the bedside on hospital day #37 (VV ECMO day #30).