To the Editor.—Hemoptysis is quite common in primary pulmonary disorders, including carcinoma and tuberculosis, as well as in mitral stenosis. Recently, we had the opportunity to evaluate and repair a unique additional cause that shows the need for exhaustive evaluation when the hemoptysis is occult in nature.
A 56-year-old farmer had a two-month history of intermittent, bright hemoptysis, initiated by exercise. He was otherwise asymptomatic and had a 40-pack year history of smoking. Aside from a hemoglobin value of 9.2 gm/100 ml, results of an extensive battery of laboratory tests, including sputum cytology and cultures, were normal. The chest roentgenogram showed mild cardiomegaly and clear lung fields, consistent with prior catheterization-documented mild aortic insufficiency. He had undergone an uneventful repair of a coarctation of the aorta seven years earlier. Results of bronchography were normal, but fiberoptic bronchoscopy showed blood in the apical-posterior segment of the left upper lobe. An