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Yoon M, Cha JG, Park J, Lee SY, Kim SH, Hong J, Park B. Endovascular Treatment of Incidentally Found Multiple Aneurysms Originating from a Bronchial Artery: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:1191-1196. [PMID: 37869109 PMCID: PMC10585086 DOI: 10.3348/jksr.2022.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/06/2023] [Accepted: 02/26/2023] [Indexed: 10/24/2023]
Abstract
Bronchial artery aneurysm (BAA) is a rare disease, and multiple aneurysms of a single bronchial artery are rarer. Regardless of the size of the lesion, it is at risk of rupture and can cause massive hemoptysis or severe pain. We report a rare case of bronchial artery embolization (BAE) of multiple aneurysms of a single bronchial artery. During medical examination, a 64-year-old female was diagnosed with multiple BAAs and endobronchial lesions in the right lower lung on CT 10 years prior to presentation to our hospital. Further evaluation of the lesions was recommended; however, the patient was lost to follow-up. The patient complained of dyspnea and visited our hospital, and the size of the BAA had increased on CT. BAE was done successfully using N-butyl-2-cyanoacrylate and detachable coils. Follow up CT after BAE showed significant decrease in extent of inflammatory lesion in the right lung.
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Chen Y, Qin W, Zhu Z, Wang X, Yu W, Li F, Li C. Interlocking detachable coil embolization for giant tandem bronchial aneurysms: A case report. Medicine (Baltimore) 2021; 100:e28416. [PMID: 34941187 PMCID: PMC8702262 DOI: 10.1097/md.0000000000028416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/06/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Bronchial artery aneurysm (BAA) is a rare disease that can be life-threatening if it ruptures. Tandem connections of multiple aneurysms are even rarer and more challenging to manage. PATIENT CONCERNS A 46-year-old woman presented to the hospital with intermittent hemoptysis for a week. A bronchial artery computed tomographic angiography scan revealed 2 BAAs associated with bronchial artery-to-pulmonary artery fistulas in the left lung. Three-dimensional CT reconstruction showed 2 bronchial aneurysms in tandem and 1 aneurysm adjacent to the descending aorta. DIAGNOSES Giant tandem bronchial aneurysms were confirmed using computerized tomographic angiography. INTERVENTIONS Nine interlocking detachable coils and 11 standard pushable coils were introduced into aneurysms for embolization. OUTCOMES There was no episodes of hemoptysis. CT angiography indicated that the coils were closely knit and in their proper position 1 month later; at follow-up, the patient had no adverse effects and no recurrence of hemoptysis. LESSONS BAA is a rare disease that can be life-threatening if it ruptures. It should be treated aggressively to determine the presence of symptoms.
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Affiliation(s)
- Yingjie Chen
- School of Medicine, Jianghan University
- Department of Pulmonary and Critical Care Medicine, Pulmonary Vascular Interventional Centre, Hemoptysis Centre, Affiliated Hospital of Jianghan University
| | - Wei Qin
- Department of Pulmonary and Critical Care Medicine, Pulmonary Vascular Interventional Centre, Hemoptysis Centre, Affiliated Hospital of Jianghan University
- Institution of Pulmonary Vascular Disease, Jianghan University, China
| | - Ziyang Zhu
- Department of Pulmonary and Critical Care Medicine, Pulmonary Vascular Interventional Centre, Hemoptysis Centre, Affiliated Hospital of Jianghan University
- Institution of Pulmonary Vascular Disease, Jianghan University, China
| | - Xiaojiang Wang
- Department of Pulmonary and Critical Care Medicine, Pulmonary Vascular Interventional Centre, Hemoptysis Centre, Affiliated Hospital of Jianghan University
- Institution of Pulmonary Vascular Disease, Jianghan University, China
| | - Wei Yu
- Department of Pulmonary and Critical Care Medicine, Pulmonary Vascular Interventional Centre, Hemoptysis Centre, Affiliated Hospital of Jianghan University
- Institution of Pulmonary Vascular Disease, Jianghan University, China
| | - Fajiu Li
- Department of Pulmonary and Critical Care Medicine, Pulmonary Vascular Interventional Centre, Hemoptysis Centre, Affiliated Hospital of Jianghan University
- Institution of Pulmonary Vascular Disease, Jianghan University, China
| | - Chenghong Li
- Department of Pulmonary and Critical Care Medicine, Pulmonary Vascular Interventional Centre, Hemoptysis Centre, Affiliated Hospital of Jianghan University
- Institution of Pulmonary Vascular Disease, Jianghan University, China
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Omachi N, Ishikawa H, Nishihara T, Yamaguchi Y, Kitaoka A, Kitaguchi K, Hattori T, Kawaguchi T. Bronchial artery aneurysm: Prevalence, clinical characteristics, and long-term prognosis following bronchial artery embolization. J Vasc Interv Radiol 2021; 33:121-129. [PMID: 34752932 DOI: 10.1016/j.jvir.2021.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/20/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To investigate the prevalence, clinical characteristics, and long-term prognosis of bronchial artery aneurysm (BAA) following bronchial artery embolization (BAE). MATERIALS AND METHODS The medical records of consecutive patients who underwent bronchial artery angiography between August 2013 to December 2019 were reviewed retrospectively. Patients who were diagnosed with BAA during this period were enrolled in this study. The prevalence, patients' characteristics, symptoms, comorbidities, angiographic findings, and long-term prognosis following BAE were investigated. RESULTS BAA was observed in 20 out of 508 patients who underwent bronchial artery angiography (3.9%). The patients' median age was 69 years (range 44-91). The main causes of BAA were cryptogenic, bronchiectasis/cystic fibrosis, and pulmonary aspergillosis. The median diameter of the ruptured BAAs was significantly smaller than that of the unruptured BAAs [5.4 mm (4.8-7.3 mm) versus 9.0 mm (7.2-13.9 mm), p = 0.009]. All patients were successfully treated with BAE without major adverse events. The median follow-up period after BAE was 970 (quartiles: 561-1796) days. The BAA-related survival rate was 100% at 2 and 3 years after BAE, and the overall survival rate after BAE was 89.2% (95% CI: 89.0-89.3) at 2 years and 74.3% (95% CI, 74.0-74.5) at 3 years. BAA related adverse events and mortality did not occur during the follow up period. CONCLUSION BAA was observed in 3.9 % (20/508) of patients who underwent bronchial artery angiography. All patients with BAA were successfully treated by BAE. BAA rupture and consequent mortality did not occur during follow up period.
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Affiliation(s)
- Naoki Omachi
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.
| | - Hideo Ishikawa
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Takashi Nishihara
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yu Yamaguchi
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Aya Kitaoka
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kazushi Kitaguchi
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tomoaki Hattori
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tomoya Kawaguchi
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
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The effect of transcatheter bronchial artery embolization in five patients with bronchial artery aneurysm. Adv Cardiol 2021; 16:330-335. [PMID: 33597999 PMCID: PMC7863811 DOI: 10.5114/aic.2020.99269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/09/2020] [Indexed: 01/21/2023]
Abstract
Introduction Due to its rarity and the lack of animal models for this disease, the etiology of bronchial artery aneurysm (BAA) is poorly understood. Aim To investigate the effect of transcatheter artery embolization (TAE) with coils, spherical polyvinyl alcohol (PVA), and gel foam in patients with BAA. Material and methods From June 2015 to November 2018, 5 patients diagnosed with BAA with massive hemoptysis after undergoing bronchial arteriography and receiving TAE therapy in the Department of Interventional Radiology were enrolled in this study. Post-embolization angiography was used to demonstrate total occlusion of the BAAs and bronchiectatic engorged vessels. The patients’ follow-up was conducted 1–16 months after TAE. Results All 5 patients were cured by the TAE treatment, during which PVA, coils, and gel foam were applied. The patients also received successful TAE via a microcatheter. Hemoptysis disappeared in all patients. No special or severe complications occurred, and no patient experienced a recurrence during the follow-up. Conclusions Overall, TAE is the best choice for patients with hemoptysis and BAA due to its effectivity and reliability. Thorough and complete embolization of the bleeding arteries is the key to successful treatment. Though PVA and coils are the most common materials for embolization, gel foam strips can also be applied.
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Xu Z, Kong Y, Hu C, Huang S, Tan Y. Ruptured Bronchial Artery Aneurysm Treated With Aortic Stent Graft and Aneurysm Embolization. Curr Med Imaging 2020; 15:74-77. [PMID: 31964330 DOI: 10.2174/1573405613666170926164225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/01/2017] [Accepted: 09/15/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Mediastinal bronchial artery aneurysms are uncommon, with fewer than 40 published case reports. This study objective was to evaluate the short term follow up of two cases ruptured Bronchial Artery Aneurysm (rBAA) treated with aneurysm embolization and subsequent aortic stent graft. METHODS Two cases of rBAA were treated with a combination of an aortic stent-graft and aneurysm embolization. With rBAA, aneurysm embolization could be performed with sodium polymannuronate until the aneurysm was almost completely packed. One of the limitations of aneurysm embolization is spontaneous recanalization of previously occluded aneurysm. So a stent-graft was deployed to isolate the feeding artery of the rBAA from the descending aorta. The 3 months follow- up after the procedure included chest or back pain and computed tomographic angiography. RESULTS The hospital stays of the 2 cases were 5 and 7 days. Chest or back pain was disappeared. There were no hospital deaths and late deaths. Computed tomographic angiogram showed no recanalization and no hemothorax. These 2 patients have not reported any complications up to now. CONCLUSION Aortic stent graft combined with aneurysm embolization is a minimally invasive, effective and safe method for rBAA.
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Affiliation(s)
- Zhiwei Xu
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Ye Kong
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Chuanxian Hu
- Department of Cardiac Surgery, Huaian No 1 Peoples Hospital, Nanjing Medical University, Jiangsu, China
| | - Su Huang
- Department of Cardiac Surgery, Huaian No 1 Peoples Hospital, Nanjing Medical University, Jiangsu, China
| | - Yan Tan
- Department of Intensive Care Unit, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
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Ectopic origin of bronchial arteries: still a potential pitfall in embolization. Surg Radiol Anat 2020; 42:1293-1298. [PMID: 32415342 DOI: 10.1007/s00276-020-02495-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the influence of ectopic origin of bronchial arteries (BAs) on bronchial artery embolization (BAE) for hemoptysis. METHODS CT and angiography images of 50 consecutive sessions in 39 patients (aged 26-93 years; mean, 70.6 years) who underwent BAE for hemoptysis from April 2010 to December 2019 were reviewed. We defined ectopic BA as a systemic artery originating from other than the T5-T6 vertebral level of the descending aorta with course along the major bronchi. The background of patients, number of BAs, culprit arteries, and treatment outcomes were compared between the cases with and without ectopic BAs. RESULTS Seventeen patients (43.6%) demonstrated 19 ectopic BAs, originating from the subclavian artery (n = 7), aortic arch above the T5-T6 level (n = 6), internal mammary artery (n = 3), brachiocephalic trunk (n = 2) or lower descending thoracic aorta (n = 1). Total number of BAs in the cases with ectopic BA was significantly greater than those in cases without ectopic BA (p = 0.0062). Required sessions of embolization were similar in the two groups. No procedure-related significant complications were noted; however, four ectopic BAs caused unexpected filling of contrast media or migration of the embolic material from the orthotopic BA to ectopic BA originating from the arch vessels via tiny communication. CONCLUSION Although BAE under the presence of ectopic BA is feasible and safe, detection of BAs with ectopic origin, even of small diameter, is needed to avoid risk of non-target coursing of embolic materials.
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Kikutani K, Itai J, Ota K, Chosa K, Yamane Y, Shime N. A Ruptured Mediastinal Bronchial Artery Aneurysm Treated with Urgent Thoracic Endovascular Aortic Repair. Intern Med 2020; 59:1283-1286. [PMID: 32074575 PMCID: PMC7303459 DOI: 10.2169/internalmedicine.4004-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Bronchial artery aneurysms (BAA) are a rare but potentially life-threatening complications because of the massive hemothorax or hemoptysis that occurs with ruptures. A 79-year-old woman was transferred to our hospital because of the sudden onset of back pain, syncope, and subsequent hypotension. Computed tomography showed a left BAA with bilateral hemothorax and hemomediastinum. Transcatheter bronchial artery embolization failed because of the anatomical location, and she went into cardiopulmonary arrest. Cardiopulmonary resuscitation was performed with successful revival. Urgent thoracic endovascular aortic repair to cover the root of the left bronchial artery was successful, and she survived without any neurological deficits.
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Affiliation(s)
- Kazuya Kikutani
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Japan
| | - Junji Itai
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Japan
| | - Kohei Ota
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Japan
| | - Keigo Chosa
- Department of Diagnostic Radiology, Hiroshima University, Japan
| | - Yoshitaka Yamane
- Department of Cardiovascular Surgery, Hiroshima University School of Medicine, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Japan
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Alharbi SR. Tuberculous esophagomediastinal fistula with concomitant mediastinal bronchial artery aneurysm-acute upper gastrointestinal bleeding: A case report. World J Gastroenterol 2019; 25:2144-2148. [PMID: 31114140 PMCID: PMC6506583 DOI: 10.3748/wjg.v25.i17.2144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/29/2019] [Accepted: 04/20/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Esophagomediastinal fistula is a very rare complication of tuberculosis in otherwise healthy adults, and mediastinal bronchial artery aneurysm is even rarer. In this case report, we describe a rare case of tuberculosis complication that presented with acute upper gastrointestinal (GI) bleeding. It also highlights the benefits of chest computed tomography (CT) as an excellent adjunct diagnostic tool to endoscopy and bronchoscopy and the role of trans-arterial embolization as a minimal invasive therapy alternative to surgery.
CASE SUMMARY A 19-year-old medically free male patient presented with acute multiple episodes of hematemesis for 1 d. Upper GI endoscopy, bronchoscopy, and chest CT with IV contrast confirmed esophagomediastinal fistula with mediastinal bronchial artery aneurysm. After resuscitating patient with IV fluid and blood product transfusion, trans catheter embolization was performed for mediastinal bronchial artery aneurysm.
CONCLUSION We successfully treated a patient with acute upper GI bleeding due to tuberculous esophagomediastinal fistula and mediastinal bronchial artery aneurysm using transcatheter coil embolization.
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Affiliation(s)
- Sultan R Alharbi
- Interventional Radiology Unit, King Saud University Medical City, Collage of Medicine, King Saud University, Riyadh 11472, Saudi Arabia
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Li Y, Gu GC, Liu B, Shao J, Chen Y, Zheng YH. Endovascular Treatment of Multiple Bronchial Artery Aneurysms With Prominent Fistula to Pulmonary Artery in a Patient With Interstitial Lung Disease: A Case Report and Literature Review. Vasc Endovascular Surg 2019; 53:492-496. [PMID: 31018831 DOI: 10.1177/1538574419845184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bronchial artery aneurysm (BAA) is a rare entity. Ruptured BAA can cause life-threatening hemorrhage. It is recommended that treatment should be initiated immediately after diagnosis. We present the case of a 56-year-old female with multiple BAAs and interstitial lung disease. Aortic computed tomography angiography demonstrated that the largest aneurysm at the right hilum was fed by right subclavian artery and right bronchial artery. A fistula between the pulmonary trunk and the aneurysm was also revealed. The patient underwent transcatheter embolization. Coils were placed in the feeding vessels instead of the aneurysms to avoid nontarget embolization of the pulmonary arteries through the fistula. The procedure achieved reduction in aneurysmal blood flow. The patient's cough resolved at 6-month follow-up.
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Affiliation(s)
- Yuan Li
- 1 Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Guang-Chao Gu
- 1 Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Bao Liu
- 1 Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Jiang Shao
- 1 Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yu Chen
- 1 Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yue-Hong Zheng
- 1 Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
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Bundy J, Srinivasa RN, Gemmete JJ, Chick JFB. Percutaneous Embolization of a Saccular Omental Artery Aneurysm. Ann Vasc Surg 2018; 54:335.e1-335.e5. [PMID: 30059760 DOI: 10.1016/j.avsg.2018.05.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/13/2018] [Accepted: 05/29/2018] [Indexed: 11/15/2022]
Abstract
Omental artery aneurysms are a unique subset of splanchnic artery aneurysms that are associated with intraperitoneal hemorrhage and high mortality rates. Detecting omental artery aneurysms prior to rupture is especially challenging; as such there are limited data surrounding unruptured aneurysms. Various methods of treating ruptured omental artery aneurysms have been previously described including omentectomy and transcatheter arterial embolization. Because of the mortality rate associated with ruptures, elective intervention in unruptured splanchnic artery aneurysms is recommended regardless of their size. This report details the successful embolization of an unruptured omental artery aneurysm utilizing a percutaneous approach.
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Affiliation(s)
- Jacob Bundy
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, Ann Arbor, MI
| | - Ravi N Srinivasa
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, Ann Arbor, MI.
| | - Joseph J Gemmete
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, Ann Arbor, MI
| | - Jeffrey Forris Beecham Chick
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, Ann Arbor, MI
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A Stepwise Embolization Strategy for a Bronchial Arterial Aneurysm: Proximal Coil and Distal Glue with the Optional Use of a Microballoon Occlusion System. Cardiovasc Intervent Radiol 2018; 41:1267-1273. [PMID: 29687263 DOI: 10.1007/s00270-018-1969-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 04/17/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to demonstrate a transcatheter embolization strategy for bronchial artery aneurysms (BAAs) using coils for the proximal lesion and glue (n-butyl-2-cyanoacrylate [NBCA]) embolization for the distal lesion with or without the use of a microballoon occlusion catheter. MATERIALS AND METHODS Five patients with BAAs presenting with hemoptysis were enrolled in this study. A bronchial angiogram indicated a mediastinal BAA near the orifice, accompanied by dilated distal branches with or without intrapulmonary BAA. A stepwise procedure was performed. First, the intrapulmonary branches were embolized with glue, with or without the use of a microballoon catheter depending upon the anatomical and local flow hemodynamic conditions. Second, the mediastinal BAA was tightly packed with detachable coils. RESULTS Glue embolization of intrapulmonary abnormal branches successfully controlled hemoptysis in all patients; microballoon catheters were used in five of the 10 arteries. The volume embolization ratio of coils within the mediastinal BAA ranged from 28 to 59%, and neither coil compaction nor signs of recanalization were observed during follow-up. CONCLUSION The stepwise embolization procedure with the sequential use of glue (with or without a microballoon occlusion system) and detachable coils may represent a possible endovascular strategy for the treatment of complex BAAs. LEVEL OF EVIDENCE IV Level 4: Case Series.
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Fankhauser G, DeAnda A. The craftsman's toolbox: Stents, coils, glue, and sometimes a scalpel. J Thorac Cardiovasc Surg 2018; 156:e119-e120. [PMID: 29625740 DOI: 10.1016/j.jtcvs.2018.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Grant Fankhauser
- Division of Vascular Surgery, University of Texas Medical Branch-Galveston, Galveston, Tex
| | - Abe DeAnda
- Division of Cardiovascular Surgery, University of Texas Medical Branch-Galveston, Galveston, Tex.
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Multiple Enlarged Aneurysms in Primary Racemose Hemangioma of the Bronchial Artery: Successful Prophylactic Transcatheter Arterial Embolization Using N-butyl-2-cyanoacrylate and Coils. Cardiovasc Intervent Radiol 2018; 41:811-815. [PMID: 29344717 DOI: 10.1007/s00270-018-1878-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
An asymptomatic 48-year-old man presented with multiple aneurysms in a primary racemose hemangioma of the right bronchial artery. Bronchial arteriography revealed a tortuous artery with four fusiform aneurysms of varying sizes and aneurysmal dilatation with marked thrombus formation in the long segment of the distal portion. Because the tip of catheter could not pass beyond the aneurysmal dilatation, we performed balloon-occluded embolization using a mixture of N-butyl-2-cyanoacrylate (NBCA) and iodized oil. For four other aneurysms, we performed embolization using a coil alone or with NBCA. After 6 months, right bronchial arteriography revealed no enhancement of the aneurysms. Despite the rarity of this procedure, embolization with NBCA is a good option for bronchial artery aneurysm embolization.
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San Norberto EM, Urbano García J, Montes JM, Vaquero C. Endovascular treatment of bronchial aneurysms. J Thorac Cardiovasc Surg 2018; 156:e109-e117. [PMID: 29452708 DOI: 10.1016/j.jtcvs.2017.12.121] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 12/10/2017] [Accepted: 12/29/2017] [Indexed: 12/20/2022]
Affiliation(s)
| | - José Urbano García
- Division of Vascular and Interventional Radiology, Jimenez Díaz Foundation University Hospital, Madrid, Spain
| | - José M Montes
- Division of Radiology, Valladolid University Hospital, Valladolid, Spain
| | - Carlos Vaquero
- Division of Vascular Surgery, Valladolid University Hospital, Valladolid, Spain
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Hou Z, Wang J, Peng D, Li C, Yang J, Wang J. Massive hemoptysis due to multiple bronchial artery aneurysms and multiple aneurysmal dilations: A case report. Radiol Case Rep 2017; 13:24-27. [PMID: 29487634 PMCID: PMC5826471 DOI: 10.1016/j.radcr.2017.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/10/2017] [Accepted: 11/13/2017] [Indexed: 01/21/2023] Open
Abstract
Bronchial artery aneurysm (BAA) is a rare but potentially life-threatening clinical entity. Patients with multiple BAAs and multiple aneurysmal dilations are even rarer. In this case report, we will investigate a case of multiple BAAs and multiple aneurysmal dilations arising from 2 right bronchial artery branches presenting with hemoptysis. The patient was successfully treated with transcatheter arterial embolization. We should be vigilant for the possibility of BAA when encountering patients presenting with hemoptysis. Transcatheter arterial embolization is safe and effective to solve this condition.
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Affiliation(s)
- Ziliang Hou
- Department of Respiratory and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Xinhuananlu No.82, Tongzhou District, Beijing 101100, China
| | - Jianfeng Wang
- Department of Interventional Therapy, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Dan Peng
- Department of Respiratory and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Xinhuananlu No.82, Tongzhou District, Beijing 101100, China
| | - Congfeng Li
- Department of Respiratory and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Xinhuananlu No.82, Tongzhou District, Beijing 101100, China
| | - Jingjing Yang
- Department of Respiratory and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Xinhuananlu No.82, Tongzhou District, Beijing 101100, China
| | - Jinxiang Wang
- Department of Respiratory and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Xinhuananlu No.82, Tongzhou District, Beijing 101100, China
- Corresponding author.
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Urlings TAJ, Irani FG, Velaga J, Too CW. Ultrasound- and Fluoroscopic-Guided Embolization of a Bronchial Artery Pseudoaneurysm in a Patient with Lung Cancer. J Vasc Interv Radiol 2017; 28:1323-1325. [PMID: 28841954 DOI: 10.1016/j.jvir.2017.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/13/2017] [Accepted: 04/14/2017] [Indexed: 11/26/2022] Open
Affiliation(s)
- Thijs August Johan Urlings
- Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Farah Gillan Irani
- Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Jyothirmayi Velaga
- Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Chow Wei Too
- Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
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17
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Ueda R, Kotani Y, Tsujimoto T. A ruptured bronchial artery aneurysm with massive haemoptysis. BMJ Case Rep 2017; 2017:bcr-2017-220392. [PMID: 28536236 DOI: 10.1136/bcr-2017-220392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Massive haemoptysis is associated with high mortality. Among various diseases presenting with massive haemoptysis, a ruptured bronchial artery aneurysm (BAA) is a rare entity. We report the case of a ruptured BAA as small as 3 mm in diameter associated with massive haemoptysis in a previously healthy 77-year-old woman. She had suddenly developed massive haemoptysis and was intubated and admitted to the intensive care unit. A CT scan and repeated bronchoscopy could not reveal the cause. Because haemorrhage continued, she underwent bronchial arteriography (BAG) twice. We finally detected a BAA with a bleb that led to the diagnosis of a ruptured BAA only 3 mm in diameter. After bronchial artery embolisation, the haemoptysis ceased. Although rare, a ruptured BAA should be considered as a cause of massive haemoptysis. Because a small BAA may get overlooked, close observation is important in BAG.
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Affiliation(s)
- Ryoma Ueda
- Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Yuki Kotani
- Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Toshihide Tsujimoto
- Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
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18
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Di X, Ji DH, Chen Y, Liu CW, Liu B, Yang J. Endovascular treatment of ectopic bronchial artery aneurysm with brachiocephalic artery stent placement and coil embolization: A case report and literature review. Medicine (Baltimore) 2016; 95:e4461. [PMID: 27583854 PMCID: PMC5008538 DOI: 10.1097/md.0000000000004461] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Bronchial artery aneurysm (BAA) is an uncommon but potentially life-threatening disease, and multiple BAAs are even rarer. Clinically, the tortuous and short neck of a BAA may present significant challenges for invasive intervention. METHODS This report describes the detailed process of diagnosis and treatment and includes a literature review of the etiology, clinical presentation, and therapeutic management of BAA. RESULTS A rare case of multiple BAAs, with one having an inflow artery arising from the brachiocephalic trunk, was referred to our hospital. The patient was successfully treated with coil embolization and brachiocephalic artery stent placement. In addition, we conducted a literature review involving 63 cases of BAA. BAA was most commonly associated with bronchiectasis and was located predominantly in the mediastinum. There was no significant difference between the diameters of the ruptured aneurysms and those of the nonruptured aneurysms (P = 0.115). Transcatheter arterial embolization was the most commonly adopted technique to treat BAA, while thoracic aortic endovascular repair was selected if the neck between the aneurysm and the aorta was short. Subgroup analysis suggested that patients with > 1 BAA were significantly more likely to be female than male (χ test, P = 0.034). CONCLUSION Transcatheter coil embolization combined with stent placement could be a reasonable treatment option for BAAs with a tortuous and short neck. According to our literature review, patients with multiple BAAs display distinctive clinical characteristics compared with patients with a single BAA.
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Affiliation(s)
- Xiao Di
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing
| | - Dong-Hua Ji
- Department of Interventional Therapy, First Affiliated Hospital of Dalian Medical University, Liaoning
| | - Yu Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing
| | - Chang-Wei Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing
- Correspondence: Bao Liu, Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing 100730, China (e-mail: )
| | - Juan Yang
- Department of Cytobiology, Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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19
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Tsunezuka Y, Tanaka N, Fujimori H. Intraoperative rupture of an interlobar bronchial artery aneurysm: a case report. J Cardiothorac Surg 2015; 10:129. [PMID: 26475343 PMCID: PMC4625440 DOI: 10.1186/s13019-015-0313-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/27/2015] [Indexed: 11/10/2022] Open
Abstract
Here we report the rare case of an intraoperative bronchial artery aneurysm (BAA) rupture. An asymptomatic 52-year-old woman was found to have bilateral, multiple dilated bronchial arteries feeding the BAA that was further connected to the pulmonary artery on computed tomography and angiography. Transcatheter arterial embolization was thought not to be succeed. During a thoracoscopic procedure, the BAA ruptured suddenly and was treated with a thoracotomy under percutaneous cardiopulmonary support (PCPS). For anatomical complex BAA like the present case, the use of an open procedure and the preparation of PCPS are strongly recommended.
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Affiliation(s)
- Yoshio Tsunezuka
- Department of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kuratsuki-higashi 2-1, Kanazawa, 920-8530, Japan.
| | - Nobuyoshi Tanaka
- Department of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kuratsuki-higashi 2-1, Kanazawa, 920-8530, Japan.
| | - Hideki Fujimori
- Department of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kuratsuki-higashi 2-1, Kanazawa, 920-8530, Japan.
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20
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Samura M, Morikage N, Yamashita O, Murakami M, Suehiro K, Hamano K. Combination of Aortic Stent Grafting and Arterial Embolization for Bronchial Artery Aneurysm Associated with Bronchial–Pulmonary Arterial Fistula. J Vasc Interv Radiol 2015; 26:1077-9. [DOI: 10.1016/j.jvir.2015.01.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 10/23/2022] Open
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21
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Abstract
Bronchial artery aneurysm (BAA) is an uncommon disease, and spontaneous rupture of an ectopic BAA can be difficult for diagnosis and life-threatening. This case study describes a 52-year-old man who presented with acute onset of right chest pain, mild tachycardia, and hypertension. The initial diagnosis of acute myocardial infarction was made, and the patient was given nitroglycerin prior to admission to our hospital. However, the patient's symptoms deteriorated. An enhanced computed tomography scan revealed a ruptured 25-mm diameter mediastinal aneurysm under the tracheal bifurcation when he was admitted to our hospital. Bronchial arteriography further demonstrated a ruptured mediastinal BAA of a bronchial artery originated from the left subclavian artery, supplying the right lobe. Transcatheter artery embolization with polyvinyl alcohol particles and microcoils was performed successfully. The patient's symptoms were gradually relieved, and without recurrence on 1 year follow-up.This case highlights the rare variation of mediastinal BAA and the role of interventional radiology in diagnosing and treating this critical condition.
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Affiliation(s)
- Yaoping Shi
- From the Department of Radiology (YS, HH); Department of Cardiothoracic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (WZ) and The Imaging Institute, Section of Interventional Radiology, Cleveland Clinic, Cleveland, Ohio, USA (WW)
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22
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Nakamura R, Inage Y, Tsuchiya A, Kato T, Yuzawa K, Koizumi M, Ueki H. Bronchial Artery Aneurysm Treated with Video-assisted Thoracoscopic Surgery. Ann Vasc Surg 2014; 28:1321.e1-3. [DOI: 10.1016/j.avsg.2013.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/29/2013] [Accepted: 12/08/2013] [Indexed: 10/25/2022]
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23
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Hori D, Noguchi K, Nomura Y, Tanaka H. Successful endovascular treatment of ruptured bronchial artery aneurysm. Asian Cardiovasc Thorac Ann 2013; 21:615-7. [DOI: 10.1177/0218492312463369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Rupture of a bronchial artery aneurysm occurs rarely and may mimic aortic dissection. A 78-year-old-man was admitted with sudden chest pain. Chest radiography showed widening of the mediastinum, suggestive of aortic dissection, but contrast-enhanced computed tomography revealed hemomediastinum and bronchial artery aneurysm. Although open surgery has been the first choice for ruptured bronchial artery aneurysm, this case was successfully treated by an endovascular procedure with the combined use of coils and a gelatin sponge.
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Affiliation(s)
- Daijiro Hori
- Department of Cardiovascular Surgery, Fujigaoka Hospital, Showa University, Kanagawa, Japan
| | - Kenichiro Noguchi
- Department of Cardiovascular Surgery, Fujigaoka Hospital, Showa University, Kanagawa, Japan
| | - Yohei Nomura
- Department of Cardiovascular Surgery, Fujigaoka Hospital, Showa University, Kanagawa, Japan
| | - Hiroyuki Tanaka
- Department of Cardiovascular Surgery, Fujigaoka Hospital, Showa University, Kanagawa, Japan
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