Hemoptysis – A Rare Initial Presentation of Descending Thoracic Aorta Aneurysm

The most common frightening symptom that brings a patient to a pulmonologist is hemoptysis. The causes of hemoptysis as such are exhaustive and source can be from simple bronchitis to malignancy. Here, we present the case of very rare cause of hemoptysis. A 60-year-old chronic smoker and alcoholic with no prior anti-tuberculosis therapy and no other co-morbidities came with acute blood stained sputum and left chest pain. Contrast-enhanced computed tomography of the chest showed aneurysmal out pouching of the descending aorta at thoracic vertebra 10–12 level with surrounding hypodense lesion with possibility of aortic aneurysm with rupture and perianeurysmal hematoma. He was planned for open surgical repair as he was not a candidate for thoracic endovascular repair, but unfortunately, he succumbed to death after a massive bout of hemoptysis during surgical workup. Although pulmonary vascular and airway diseases are the most common causes of hemoptysis, aortic aneurysms with dissection can also be the cause of hemoptysis and it also has to be borne in mind as differential diagnosis, especially when the lesion is in perihilar region.