Description

A 60-year-old man presented with a 4-day history of small volume haemoptysis. His medical history revealed a pericardiectomy with pericardial window creation for severe constrictive pericarditis secondary to seropositive rheumatoid arthritis in 1997 and pulmonary tuberculosis aged 7, with a treated recurrence in 2005. He was a lifelong smoker of 20 cigarettes per day. He lived independently. His regular medication included prednisolone 10 mg and meloxicam.

On examination, he looked unwell. His heart rate was 140, respiratory rate 22 and oxygen saturations 96% on air. Auscultation revealed crepitations at the left lung base. He had 500 mL of brisk haemoptysis. His haemoglobin fell from 85 to 73 g/L. Inflammatory markers were raised (C reactive protein 169 mg/L, white cell count 14.7×10⁹/L, neutrophil count 12.9×10⁹/L), prothrombin time ratio was mildly raised (1.4), platelet count was …