Introduction Bleeding from bronchial varices is a rare cause of hem- optysis [1]. Although bronchial varices are more com- monly associated with primarily bronchial or pulmonary disease, the bronchial veins can also dilate with in- creased pulmonary venous pressure secondary to mitral stenosis [1] or pulmonary venous obstruction [2]. Only a few papers have described association of pulmonary venous obstruction with bronchial varices and hemopt- ysis [1, 3, 4]. As far as we know, none of the previously reported cases have been diagnosed by medical imaging. This case report correlates the CT with bronchoscopic findings of bronchial varices in a patient with unilateral pulmonary venous obstruction. Case report An 18-month-old boy had repeated episodes of hemoptysis. He was born at 26 months gestation by cesarean section (mother had a medical history of IgA nephropathy). He suffered a long and complicated neonatal course. The initial complication was respiratory insufficiency due to immaturity (requiring high-fre- quency ventilation). He also developed bilateral intraventricular hemorrhage, retinopathy of prematurity, patent ductus arteriosus and sepsis with multiorgan failure. At 3 months of age he devel- oped small-bowel necrosis, requiring a temporary jejunostomy for 2 months. Because of poor nutritional status, a gastric tube was inserted at 7 months of age. At 4.5 months of age he required a tracheostomy for long-term ventilation following several attempts at extubation. Chest CT at 8 months of age showed changes compatible with bronchopulmonary dysplasia. He was eventually discharged home on nocturnal ventilation at 11 months of age. At 15 months of age he presented to emergency with a history of repeated hemoptysis (5–10 ml at a time). Rigid bronchoscopy revealed frank blood from his left upper lobe bronchus. Subsequent chest CT showed narrowing of the left main bronchus, with apparent bronchiectasis of the left lower lobe bronchi. He was treated medically with antibiotics. He was then weaned from ven- tilation but continued on oxygen therapy. A second rigid bron- choscopy was performed at 18 months of age because of multiple failed attempts at closing the tracheostomy due to respiratory distress. Bronchoscopy revealed severe subglottic stenosis. He presented 1 week later to emergency with hemoptysis (again approximately 5 ml). A flexible bronchoscopy was therefore performed via the tracheostomy which revealed a narrow, ery- thematous left main bronchus. The airway mucosa appeared pink, markedly hyperemic, with dilated submucosal vessels arising circumferentially at the orifice of the left main bronchus (Fig. 1a) and passing distally, visible throughout the entire left bronchial Sheldon Wiebe Ian Maclusky David Manson Stephanie Holowka Shi-Joon Yoo Hemoptysis: a rare cause can be related to a bronchial varix due to pulmonary venous obstruction Received: 27 January 2003 Revised: 26 March 2003 Accepted: 10 April 2003 Published online: 9 September 2003 Ó Springer-Verlag 2003 Abstract Bronchial varices, which have rarely been described in the radiology literature, can be the result of pulmonary venous obstruction and may present with hemoptysis. This case is an illustration of this rare condition, which correlates CT findings with bronchoscopic find- ings. We also describe the findings on phase-contrast MR that demon- strated reversed diastolic flow in the branch pulmonary artery supplying the affected lung. Keywords Hemoptysis Æ Pulmonary obstruction Æ Varix Pediatr Radiol (2003) 33: 884–886 DOI 10.1007/s00247-003-0971-0 CASE REPORT S. Wiebe Æ I. Maclusky Æ D. Manson S. Holowka Æ S.-J. Yoo (&) The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada E-mail: shi-joon.yoo@sickkids.on.ca Tel.: +1-416-8136037 Fax: +1-416-8137591