Abstract Introduction Diffuse alveolar hemorrhage (DAH) is a serious pulmonary condition characterized by bleeding into the alveolar spaces. While common causes include vasculitis, autoimmune disease, and infection, delayed radiation-induced vascular injury is an uncommon etiology. We present a case of DAH occurring three decades after pulmonary artery radiation for choriocarcinoma. Case Presentation A 58-year-old woman with a remote history of choriocarcinoma treated 30 years earlier with pulmonary artery radiation presented with acute hemoptysis and new-onset atrial fibrillation with rapid ventricular response. She was not anticoagulated. CT chest demonstrated bilateral ground-glass opacities, interlobular septal thickening, and areas of mosaic attenuation without evidence of pulmonary embolism, pseudoaneurysm, or recurrent tumor. Serum β-hCG was normal, ruling out recurrence of choriocarcinoma. She developed worsening hemoptysis requiring intubation. Bronchoscopy revealed progressively bloody lavage from both lower lobes without a focal bleeding source, consistent with diffuse alveolar hemorrhage. Vasculitis workup (ANA, ANCA, anti-GBM, complement) was negative, and renal function remained normal. She received pulse-dose corticosteroids with improvement in oxygenation and no further bleeding. Discussion With vasculitis, infection, and tumor recurrence excluded, the most likely cause of DAH was delayed radiation-induced vascular injury. Radiation-related endothelial damage may result in fragile capillary networks prone to rupture, even decades after exposure. Recognition of this delayed complication is essential in patients with prior thoracic irradiation presenting with hemoptysis. Conclusion Radiation-induced vascular fragility should be considered in the differential diagnosis of diffuse alveolar hemorrhage in patients with a remote history of chest irradiation, after ruling out other potential causes. Early bronchoscopy and corticosteroid therapy remain key components of diagnosis and management. This abstract is funded by: none
Philip et al. (Fri,) studied this question.