31 Bronchial Artery Embolizaton

Clinical Presentation

A 45-year-old male with a history of pulmonary tuberculosis presented to the emergency department with severe hemoptysis. Bronchoscopy showed active bleeding within the left main bronchus, limiting further evaluation.

Figure 31-1 Diagnosis and treatment of a patient with massive hemoptysis. (A) Chest radiograph shows bilateral interstitial lung disease with predominantly right-sided cavitation and interstitial lung disease. (B) Descending aortogram shows the level of a right-sided bronchial artery. (C) Selected bronchial angiography shows increased vascularity in the distribution of a right bronchial artery but no active extravasation of contrast material. (D) Selected angiography of a second bronchial artery more distal shows a common trunk supplying the right and left sides. (E) Selected bronchial angiography after embolization using polyvinyl alcohol particles shows cessation of flow. Both bronchial arteries were embolized.

Radiologic Studies

Radiography

Chest radiograph showed bilateral interstitial lung disease with predominantly right-sided cavitation and interstitial lung disease.

Angiography

The right common femoral artery was punctured using the Seldinger technique, and a 5-French (F) sheath was inserted. A descending aortogram showed the level of a right-sided bronchial artery. The bronchial arteries were selected using a Cobra 2 catheter (Boston Scientific, Natick, Massachusetts), and angiography was performed showing increased vascularity in the distribution a right bronchial artery but no active extravasation of contrast material. A second bronchial artery supplied both the right and left sides, and increased vascularity to the right upper lobe was again seen.

Diagnosis

Bronchial artery rupture caused by tuberculosis.

Treatment

Superselective Embolization

A 3F microcatheter was advanced through the Cobra catheter (Boston Scientific, Natick, Massachusetts) into both bronchial arteries. Angiography again revealed increased vascularity in this distribution. Embolization was performed by injection of 500 to 700 micron particles until stasis of flow was achieved.