Henry Ford Hospital Medical Journal


The differential diagnosis of hemoptysis in patients with mitral stenosis includes many primary pulmonary problems besides those peculiar to mitral stenosis. We describe the case of a 40-year-old woman with a 40-pack-year smoking history whose presenting symptom of hemoptysis was wrongly ascribed to pulmonary embolus and infarction, based on a presumably positive angiogram, and to chronic bronchitis, based on endoscopic findings at fiberoptic bronchoscopy, as provided by the referring physician. The features differentiating between cardiac and primary pulmonary disease are described, and the pathophysiology of hemoptysis in mitral stenosis is reviewed. In a case like the one we describe, hemoptysis is an important manifestation of severe valvular stenosis, and surgical intervention, i.e., mitral commissurotomy or mitral valve replacement, should be considered.