Abstract Introduction Postcoital hemoptysis (PCH) is a rare phenomenon linked to underlying cardiac, respiratory and vascular pathologies. Intercourse triggers a surge in catecholamines resulting in abrupt increases in systemic and pulmonary vascular pressures. In susceptible individuals, this hemodynamic stress may exceed pulmonary capillary integrity, leading to alveolar hemorrhage. Case Study A 61-year-old woman with a 39 pack-year smoking history presented with a 4-month history of hemoptysis, occurring solely during sexual intercourse, specifically at orgasm. She reported two self-limited episodes without associated respiratory symptoms. Her medical history included left popliteal artery exploration (negative for entrapment), complicated by varicose vein formation and subsequent vein stripping. Physical exam was unremarkable except for increased left calf tone. Lower extremity ultrasound was negative for DVT. CTA chest ruled out pulmonary embolism and vascular malformations. Echocardiogram was remarkable for preserved LV function, RV enlargement with normal systolic function, borderline RA dilation, and trace mitral regurgitation. Vasculitis serologies were negative. Bronchoscopy showed no endobronchial abnormalities. Cryobiopsies from the right lower and middle lobes showed lung alveolar and bronchial tissue with focuses of inflammation and hemorrhage, without definitive vasculitis and capillaritis. Bronchoalveolar lavage revealed abundant hemosiderin-laden macrophages—confirmation of prior alveolar hemorrhage—with no infectious organisms or malignant cells identified. Discussion The pathophysiology of PCH is likely multifactorial. Although initial work up was unrevealing, a pending scheduled dynamic right heart catheterization may uncover occult cardiopulmonary pathology that only manifests under physiologic stress. It is unclear if prior vascular interventions and positional changes during intercourse may contribute to symptom onset. Our case underscores the unique cardiopulmonary stress of intercourse and emphasizes the need for thorough, dynamic evaluation in isolated PCH. This case study of PCH is distinguished by the acquisition of a high-quality lung cryobiopsy, which was instrumental in definitively excluding vasculitis. This abstract is funded by: NONE
Martinez et al. (Fri,) studied this question.