Bronchial Dieulafoy’s disease complicated by pulmonary embolism after successful hemostasis: a case report and review of the literature

Background Bronchial Dieulafoy’s disease (BDD) is a rare vascular anomaly characterized by a large-caliber submucosal artery that can cause sudden, massive, and potentially fatal hemoptysis. Because of its deceptively benign endobronchial appearance, the disease is frequently underrecognized and carries a high risk of catastrophic bleeding following bronchoscopic manipulation. Case presentation A 77-year-old woman without underlying lung disease developed massive hemoptysis and hemorrhagic shock shortly after diagnostic bronchoscopy for an indeterminate endobronchial lesion. Emergency bronchial artery embolization (BAE) achieved durable hemostasis. During recovery, the patient developed intermediate-risk pulmonary embolism, posing a major therapeutic dilemma regarding anticoagulation after recent life-threatening airway bleeding. A stepwise anticoagulation strategy was cautiously implemented after secure hemostasis, resulting in complete resolution of pulmonary embolism without recurrent hemoptysis. Histopathological examination confirmed the diagnosis of bronchial Dieulafoy’s disease. Conclusions This case highlights the diagnostic pitfalls of bronchial Dieulafoy’s disease, the lifesaving role of bronchial artery embolization, and the complexity of managing thromboembolic complications following control of massive hemoptysis. Clinicians should maintain a high index of suspicion for BDD in patients with unexplained hemoptysis and benign-appearing endobronchial lesions, and bronchoscopic biopsy should be avoided whenever a vascular etiology is suspected.