Primary racemose hemangioma with bronchial-pulmonary arterial fistula

Huge racemose hemangioma of the bronchial artery with arterial supply via the right coronary artery and left internal thoracic artery

A 79-year-old male with bronchiectasis was referred to our clinic because of mild chest tightness on exertion. He had no history of hemoptysis. An electrocardiogram showed ST segment depression in leads V5-6. Multi-detector contrast-enhanced computed tomography revealed no significant stenosis in either coronary artery; however, a huge racemose hemangioma of the bronchial artery (RHBA) was detected. In addition, arterial supply to the RHBA via the right coronary artery (RCA) and the left internal thoracic artery (LITA) was suspected. Adenosine-loading myocardial scintigraphy images revealed segmental hypo-perfusion in the left ventricular inferior wall. Selective bronchial artery angiography revealed the huge RHBA. In addition, both the RCA and LITA provided arterial supply to the RHBA. To the best of our knowledge, this case is the first to show multiple arterial supply resulting in a huge RHBA.

A case of primary racemose hemangioma in which the disappearance of an endobronchial lesion was confirmed after bronchial artery embolization

The confirmation of the improvement of endobronchial lesions in addition to that of vascular lesions after bronchial artery embolization of primary racemose hemangioma could be important.

A Surgical Case of Bronchial Artery Aneurysm Connecting to a Pulmonary Artery and Vein Complicated by Racemose Hemangioma

We report a surgical case of bronchial artery aneurysm (BAA) that directly connected to a pulmonary artery and a pulmonary vein through an abnormal vessel. It was complicated by racemose hemangioma. This is a rare vascular malformation. An 82-year-old female had a large BAA that was found incidentally. First, we consider treating the BAA with embolization by interventional radiology (IVR). However, because of strong meandering of the bronchial artery, we could not advance a microcatheter into the BAA. Therefore, a surgical operation was performed through a standard posterior lateral thoracotomy. The BAA was located between the upper and lower lobes and directly connected to the pulmonary artery. Some bronchial artery branches that provided inflow to the aneurysm were ligated, and the abnormal vessel that connected the BAA to the upper pulmonary vein was ligated easily. A fistula between the BAA and pulmonary artery was sutured by the cardiovascular surgeon using an artificial cardiopulmonary device, with permissive stenosis of A2b (ascending A2).