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Bronchial artery embolization for management of massive cryptogenic hemoptysis: a case series.

Samara KD, Tsetis D, Antoniou KM, Protopapadakis C, Maltezakis G, Siafakas NM - J Med Case Rep (2011)

Bottom Line: Swift and effective management is of crucial importance, especially in severe, life-threatening cases.We discuss the results and management of the patients, and review the literature.All cases were followed up for 12 months, and there was no recurrence of bleeding.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic Medicine, University of Crete Medical School, Heraklion, Crete, Greece. kat_samara@hotmail.com.

ABSTRACT

Introduction: Hemoptysis constitutes a common and urgent medical problem. Swift and effective management is of crucial importance, especially in severe, life-threatening cases. In cases of idiopathic hemoptysis, in which no underlying pulmonary pathology can be identified, treatment is challenging. We report our experience with bronchial artery embolization in the treatment of massive idiopathic hemoptysis.

Cases presentation: We report three consecutive cases of acute severe idiopathic hemoptysis. Our patients (two men aged 51 and 56 years and one woman aged 46 years), were of Caucasian ethnicity. We discuss the results and management of the patients, and review the literature. All three patients were treated safely and successfully with transcatheter embolization of the bronchial arteries using tris-acryl gelatin microspheres. Hemoptysis was controlled. All cases were followed up for 12 months, and there was no recurrence of bleeding.

Conclusion: Bronchial artery embolization is an effective tool for the evaluation and treatment of massive idiopathic hemoptysis.

No MeSH data available.


Related in: MedlinePlus

Selective catheterization of a hypertrophic right bronchial artery in a 56-year-old man with two episodes of severe hemoptysis. Bronchoscopy detected only some blood trails and clots in the right bronchial system, without conclusive evidence as to the origin of bleeding. Selective angiography of a hypertrophic right bronchial artery through a 5F cobra catheter demonstrates moderate hypervascularity, more prominent in the right upper lobe.
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Figure 1: Selective catheterization of a hypertrophic right bronchial artery in a 56-year-old man with two episodes of severe hemoptysis. Bronchoscopy detected only some blood trails and clots in the right bronchial system, without conclusive evidence as to the origin of bleeding. Selective angiography of a hypertrophic right bronchial artery through a 5F cobra catheter demonstrates moderate hypervascularity, more prominent in the right upper lobe.

Mentions: The next step was bronchial angiography followed by embolization. Under local anesthesia, the common femoral artery was percutaneously punctured, and a 5F introduction sheath was inserted. A flush catheter was advanced into the upper part of the descending thoracic aorta, and a diagnostic anteroposterior angiogram was performed, which in all three cases revealed the hypertrophic bronchial arteries. The hypertrophic bronchial arteries were then selectively catheterized with a 5F cobra-shaped curved catheter. The angiogram showed minimal to moderate hypervascularity in the right upper lobe in two cases (Figure 1), whereas in the third case, no hypervascularity or other obvious vascular abnormality was detected. Transcatheter embolization of the hypertrophic bronchial arteries of the right upper lobe was subsequently performed through the catheter after stabilization of the catheter tip was confirmed (Figure 2). A microcatheter was not used, as there was no opacification of the important spinal branches in any of our three patients. Tris-acryl gelatin microspheres (Embosphere®; BioSphere Medical Inc, Marlborough, MA, USA) 500-700 μm in diameter, were used as the embolization material, and were injected slowly through 1 ml syringes. The embolic particles were dispersed in contrast medium to allow visualization of any backflow and to monitor for progressive slowing of flow. Throughout the procedure, regular angiograms were performed to detect previously invisible connections to side branches supplying the spinal cord. Embolization was terminated when the antegrade flow ceased.


Bronchial artery embolization for management of massive cryptogenic hemoptysis: a case series.

Samara KD, Tsetis D, Antoniou KM, Protopapadakis C, Maltezakis G, Siafakas NM - J Med Case Rep (2011)

Selective catheterization of a hypertrophic right bronchial artery in a 56-year-old man with two episodes of severe hemoptysis. Bronchoscopy detected only some blood trails and clots in the right bronchial system, without conclusive evidence as to the origin of bleeding. Selective angiography of a hypertrophic right bronchial artery through a 5F cobra catheter demonstrates moderate hypervascularity, more prominent in the right upper lobe.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3049744&req=5

Figure 1: Selective catheterization of a hypertrophic right bronchial artery in a 56-year-old man with two episodes of severe hemoptysis. Bronchoscopy detected only some blood trails and clots in the right bronchial system, without conclusive evidence as to the origin of bleeding. Selective angiography of a hypertrophic right bronchial artery through a 5F cobra catheter demonstrates moderate hypervascularity, more prominent in the right upper lobe.
Mentions: The next step was bronchial angiography followed by embolization. Under local anesthesia, the common femoral artery was percutaneously punctured, and a 5F introduction sheath was inserted. A flush catheter was advanced into the upper part of the descending thoracic aorta, and a diagnostic anteroposterior angiogram was performed, which in all three cases revealed the hypertrophic bronchial arteries. The hypertrophic bronchial arteries were then selectively catheterized with a 5F cobra-shaped curved catheter. The angiogram showed minimal to moderate hypervascularity in the right upper lobe in two cases (Figure 1), whereas in the third case, no hypervascularity or other obvious vascular abnormality was detected. Transcatheter embolization of the hypertrophic bronchial arteries of the right upper lobe was subsequently performed through the catheter after stabilization of the catheter tip was confirmed (Figure 2). A microcatheter was not used, as there was no opacification of the important spinal branches in any of our three patients. Tris-acryl gelatin microspheres (Embosphere®; BioSphere Medical Inc, Marlborough, MA, USA) 500-700 μm in diameter, were used as the embolization material, and were injected slowly through 1 ml syringes. The embolic particles were dispersed in contrast medium to allow visualization of any backflow and to monitor for progressive slowing of flow. Throughout the procedure, regular angiograms were performed to detect previously invisible connections to side branches supplying the spinal cord. Embolization was terminated when the antegrade flow ceased.

Bottom Line: Swift and effective management is of crucial importance, especially in severe, life-threatening cases.We discuss the results and management of the patients, and review the literature.All cases were followed up for 12 months, and there was no recurrence of bleeding.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic Medicine, University of Crete Medical School, Heraklion, Crete, Greece. kat_samara@hotmail.com.

ABSTRACT

Introduction: Hemoptysis constitutes a common and urgent medical problem. Swift and effective management is of crucial importance, especially in severe, life-threatening cases. In cases of idiopathic hemoptysis, in which no underlying pulmonary pathology can be identified, treatment is challenging. We report our experience with bronchial artery embolization in the treatment of massive idiopathic hemoptysis.

Cases presentation: We report three consecutive cases of acute severe idiopathic hemoptysis. Our patients (two men aged 51 and 56 years and one woman aged 46 years), were of Caucasian ethnicity. We discuss the results and management of the patients, and review the literature. All three patients were treated safely and successfully with transcatheter embolization of the bronchial arteries using tris-acryl gelatin microspheres. Hemoptysis was controlled. All cases were followed up for 12 months, and there was no recurrence of bleeding.

Conclusion: Bronchial artery embolization is an effective tool for the evaluation and treatment of massive idiopathic hemoptysis.

No MeSH data available.


Related in: MedlinePlus