Thompson et al. Journal of Medical Case Reports 2010, 4:17 http://www.jmedicalcasereports.com/content/4/1/17 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Haemoptysis in pregnancy caused by a well-differentiated fetal adenocarcinoma: a case report Rebecca J Thompson1*, Philip S Hasleton2,3, Paul M Taylor4, Mark Woodhead3,5, Louise M Byrd1 Abstract Introduction: Haemoptysis in pregnancy is frequently assumed to be caused by a pulmonary embolism. However, it can also be an indicator of serious pathology. Case presentation: We report the case of a 27-year-old Caucasian woman who presented with haemoptysis in pregnancy that was discovered to be caused by a well-differentiated fetal adenocarcinoma of the lung. Conclusion: This case demonstrates the importance of establishing an accurate diagnosis when a pregnant woman presents with haemoptysis and that more serious pathology should be considered if the clinical symptoms persist and/or the presumed diagnosis of pulmonary embolism is not confirmed. Introduction When the symptom of haemoptysis occurs in preg- nancy, it is frequently assumed to be caused by a pul- monary embolism, which is a relatively common pathology in pregnancy. However, as in the non-preg- nant population, it can be caused by a number of other conditions and can be an indicator of serious pathology. Here we present a case of haemoptysis in pregnancy caused by a well-differentiated fetal adenocarcinoma of the lung. Case presentation A 27-year-old Caucasian woman, gravida 2 para 1, booked at 13 weeks gestation. An ultrasound scan con- firmed an estimated date of delivery of April 19, 2007. She was a fitness instructor, and had no significant past medical history, aside from a chest infection prior to this pregnancy that was treated with antibiotics by her General Practitioner. A smoker since the age of 17 years (approximately ten cigarettes per day), she had stopped six months previously. The index pregnancy proceeded uneventfully until she presented with haemoptysis to her local hospital at 25 weeks gestation. A chest x-ray suggested a possible * Correspondence: becky_thompson@hotmail.co.uk 1Department of Obstetrics and Gynaecology, St Mary’s Hospital, Hathersage Road, Manchester M13 9WL, UK right-sided pneumonia. She was prescribed a course of antibiotics, and discharged home. When seen in the antenatal clinic at 28 weeks gesta- tion, she reported further episodes of haemoptysis. She was therefore admitted immediately for investigation. The working diagnosis was pulmonary embolism and as such she was fully anticoagulated with low molecular weight heparin (LMWH). Arterial blood gases breathing air were within normal limits (pO2 92.5 mmHg, 12.3 kPa; pCO2 33.6 mmHg 4.47 kPa), and sputum cultured normal upper respiratory tract flora. A chest x-ray (Fig- ure 1) demonstrated a small right basal pleural reaction and some right basal atelectasis, which may indicate pul- monary embolic disease. A perfusion lung (V/Q) scan gave an indeterminate risk of pulmonary embolus. Nevertheless, despite several days of adequate treatment with LMWH (post dose Factor Xa 0.6), she had contin- ued haemoptysis and a respiratory opinion was therefore sought. As a pulmonary embolus had as yet not been confirmed and the condition of the patient appeared to be worsening despite adequate therapy, bilateral leg Doppler’s and a computed tomography pulmonary angiogram (CTPA) were performed. The former showed no evidence of a deep vein thrombosis. The latter revealed no pulmonary embolus but rather a cavitating mass of 4 cm in diameter within the right lung, © 2010 Thompson et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.