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Copping R, Ng N, Osman S. Selective embolisation of an idiopathic bronchial artery pseudoaneurysm presenting with recurrent laryngeal nerve palsy: a case report. CVIR Endovasc 2024; 7:62. [PMID: 39138755 PMCID: PMC11322463 DOI: 10.1186/s42155-024-00474-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/05/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Bronchial artery pseudoaneurysms (BAP) or aneurysms (BAA) are rare, potentially life-threatening and remain poorly understood. They are most commonly idiopathic but may be associated with a number of other disease processes. Bronchial artery embolisation (BAE) is considered the first line treatment while surgical techniques are reserved for patients with a clear contraindication to embolisation or where anatomical factors preclude an endovascular approach. CASE PRESENTATION We present an interesting case of a 56 year-old male presenting with an idiopathic unruptured right BAP causing clinical and radiological signs of left recurrent laryngeal nerve (RLN) palsy. He was otherwise clinically well with no other reported symptoms and no significant past medical history. There were no significant findings on work-up and investigation. He was ultimately treated successfully with selective transarterial coil embolization of the right bronchial artery. This is an atypical presentation of a rare clinical entity and has not previously been published in the literature to our knowledge. CONCLUSIONS BAPs and BAAs are highly variable in their presentation, ranging from incidental asymptomatic findings to catastrophic haemorrhage, depending on their location and if they are contained or ruptured. Timely diagnosis and referral to facilitate urgent embolisation is essential to prevent potentially serious clinical sequelae. Endovascular treatment in the form of BAE is considered first line.
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Affiliation(s)
- R Copping
- Interventional Radiology Department, Liverpool Hospital, New South Wales, Australia.
- UNSW Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales, Sydney, Australia.
| | - N Ng
- Interventional Radiology Department, Liverpool Hospital, New South Wales, Australia
| | - S Osman
- Interventional Radiology Department, Liverpool Hospital, New South Wales, Australia
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2
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Yu MH, Kang NG, Jung JH. Delayed Diagnosis and Successful Glue Embolization of a Post-Traumatic Bronchial Artery Pseudoaneurysm: A Case Report. Mil Med 2024:usae370. [PMID: 39058705 DOI: 10.1093/milmed/usae370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/16/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Bronchial artery pseudoaneurysms (BAPs) are rare but potentially fatal vascular anomalies. We present a case of a 21-year-old male soldier who developed a BAP following a fall sustained during a suicide attempt. The BAP was identified on computed tomography angiography (CTA) and successfully treated with trans-arterial glue embolization. The patient's recovery was uncomplicated. To our knowledge, only one prior case of post-traumatic BAP treated with endovascular intervention has been reported in the literature (29 years ago). Due to the risk of significant morbidity and mortality associated with BAP rupture, prompt diagnosis and treatment are crucial. Endovascular embolization is a safe and effective treatment option for BAPs. This case highlights the effectiveness of glue embolization as a treatment modality for BAPs.
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Affiliation(s)
- Min-Hyuk Yu
- Department of Radiology, Armed Forces Capital Hospital, Bundang-gu, Seongnam 13574, Republic of Korea
| | - Nam-Gyu Kang
- Department of Radiology, Armed Forces Capital Hospital, Bundang-gu, Seongnam 13574, Republic of Korea
| | - Jae-Hyeop Jung
- Remote Reading Team, Armed Forces Capital Hospital, Bundang-gu, Seongnam 13574, Republic of Korea
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3
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Suzuki M, Hojo M, Sugiyama H. Idiopathic multiple bronchial artery aneurysms and racemose haemangioma without symptoms. BMJ Case Rep 2024; 17:e258606. [PMID: 38176756 PMCID: PMC10773295 DOI: 10.1136/bcr-2023-258606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Affiliation(s)
- Manabu Suzuki
- Respiratory Medicine, National Center for Global Health and Medicine Hospital, Shinjuku-ku, Japan
| | - Masayuki Hojo
- Respiratory Medicine, National Center for Global Health and Medicine Hospital, Shinjuku-ku, Japan
| | - Haruhito Sugiyama
- Respiratory Medicine, National Center for Global Health and Medicine Hospital, Shinjuku-ku, Japan
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4
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Multimodality Image-Guided Embolization of Bronchial Artery Pseudoaneurysm in a Patient With Aortopathy. JACC Case Rep 2022; 4:721-726. [PMID: 35734533 PMCID: PMC9207955 DOI: 10.1016/j.jaccas.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/01/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022]
Abstract
A 59-year-old man received an incidental diagnosis of a 5-cm right para-aortic mass that was initially thought to be of venous origin. Multimodality imaging revealed a right bronchial artery pseudoaneurysm that was treated with endovascular embolization. Bronchial artery pseudoaneurysms are extremely rare and can be fatal if ruptured. (Level of Difficulty: Advanced.)
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5
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Hayashi K, Hanaoka J, Kita Y. Bronchial artery aneurysm presenting with epigastric pain that improves with vomiting. Respirol Case Rep 2022; 10:e0960. [PMID: 35601805 PMCID: PMC9112191 DOI: 10.1002/rcr2.960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/23/2022] [Indexed: 11/08/2022] Open
Abstract
A 64-year-old man presented to the emergency department with a chief complaint of epigastric pain that improved with vomiting. He was initially treated for gastrointestinal disease, but computed tomography (CT) showed a mediastinal haematoma and contrast-enhanced CT and bronchial arteriography showed a bronchial aneurysm. Bronchial artery aneurysm is a rare but potentially life-threatening condition that can lead to haemorrhagic shock if it ruptures. Patients with bronchial aneurysms may present with symptoms similar to that of gastrointestinal diseases owing to increased pressure in the mediastinum caused by mediastinal haematoma.
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Affiliation(s)
- Kazuki Hayashi
- Department of General Thoracic Surgery Omi Medical Center Kusatsu Japan.,Division of General Thoracic Surgery, Department of Surgery Shiga University of Medical Science Otsu Japan
| | - Jun Hanaoka
- Division of General Thoracic Surgery, Department of Surgery Shiga University of Medical Science Otsu Japan
| | - Yusuke Kita
- Department of General Thoracic Surgery Omi Medical Center Kusatsu Japan
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6
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Balar AB, Lakhani DA, Martin D, Smith KT, Kim C. Giant mediastinal bronchial artery aneurysm mimicking mediastinal mass: A case report and brief review of the literature. Radiol Case Rep 2022; 17:1496-1501. [PMID: 35265248 PMCID: PMC8898754 DOI: 10.1016/j.radcr.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
Bronchial artery aneurysm and pseudoaneurysm is a rare but life-threatening diagnosis due to catastrophic complications from rupture. Prompt detection and management is key to prevent complications. CT angiogram and digital subtraction angiography are preferred diagnostic imaging modalities. Being very uncommon, these entities can be misdiagnosed as a nonspecific mediastinal soft tissue mass, which can lead to delay in diagnosis and inappropriate or delayed management. We present a case of 72-year-old woman with incidentally detected large bronchial artery pseudoaneurysm, incorrectly classified as mediastinal malignancy at outside facility, receiving follow-up exams for 2 years, before correct diagnosis and management.
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7
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Lin JL, Ji YY, Zhang MZ, Tang Y, Wang RL, Ruan DD, Zhou YF, Wu SJ, Cai SL, Zhang JH, Meng XR, Luo JW, Fang ZT. Rare Cases of Bronchial Aneurysm and Comparison of Interventional Embolization in the Treatment of True Bronchial Aneurysm and Pseudobronchial Aneurysm. Front Cardiovasc Med 2022; 9:856684. [PMID: 35355974 PMCID: PMC8959610 DOI: 10.3389/fcvm.2022.856684] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/17/2022] [Indexed: 12/02/2022] Open
Abstract
Background Bronchial artery aneurysm (BAA) is a rare disease. Rupture of BAA can lead to life-threatening hemoptysis, and once diagnosed, treatment is needed regardless of symptoms. Transcatheter artery embolization is the first choice of treatment because it is minimally invasive and effective. This study aimed to retrospectively compare the embolization treatment of a case of true BAA and that of a pseudobranchial aneurysm and explore the choice of embolization method for BAA with short neck or no neck. Materials and Methods Embolization treatment and imaging characteristics of one case of true BAA and one case of pseudobronchial aneurysm admitted to our hospital were analyzed retrospectively. Embolization methods and therapeutic effects of two cases of BAAs were compared. Results Case 1 was that of an intact true BAA inside the mediastinum located at the opening of the bronchial artery. The distal end of the aneurysm was embolized, and tumor cavity was occluded. No recurrence of BAA was found after the operation. Case 2 was that of a ruptured and hemorrhagic pseudobronchial aneurysm of the mediastinum. Coil embolization combined with covered stent graft exclusion of the thoracic aorta were performed, and the left bronchial artery and BAA were almost occluded. Nine months postoperatively, the mediastinal hematoma was almost completely absorbed. Conclusion Endovascular embolization has become the most commonly used for the treatment of BAA. Different methods should be selected according to the location and nature of the aneurysm.
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Affiliation(s)
- Jia-Li Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yuan-Yuan Ji
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Ming-Zhe Zhang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yi Tang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, China
| | - Ruo-Li Wang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Dan-Dan Ruan
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yan-Feng Zhou
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, China
| | - Shao-Jie Wu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, China
| | - Sen-Lin Cai
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, China
| | - Jian-Hui Zhang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Xiao-Rong Meng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jie-Wei Luo
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- *Correspondence: Jie-Wei Luo,
| | - Zhu-Ting Fang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, China
- Zhu-Ting Fang,
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8
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Sherwani P, Kumar KSS, Sharma P, Dua R, Layek A. Ruptured spontaneous bronchial artery pseudo aneurysm with large mediastinal hematoma and its interventional management: An acute chest emergency. Lung India 2022; 39:204-207. [PMID: 35259809 PMCID: PMC9053928 DOI: 10.4103/lungindia.lungindia_540_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Marquis KM, Raptis CA, Rajput MZ, Steinbrecher KL, Henry TS, Rossi SE, Picus DD, Bhalla S. CT for Evaluation of Hemoptysis. Radiographics 2021; 41:742-761. [PMID: 33939537 DOI: 10.1148/rg.2021200150] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Hemoptysis, which is defined as expectoration of blood from the alveoli or airways of the lower respiratory tract, is an alarming clinical symptom with an extensive differential diagnosis. CT has emerged as an important noninvasive tool in the evaluation of patients with hemoptysis, and the authors present a systematic but flexible approach to CT interpretation. The first step in this approach involves identifying findings of parenchymal and airway hemorrhage. The second step is aimed at determining the mechanism of hemoptysis and whether a specific vascular supply can be implicated. Hemoptysis can have primary vascular and secondary vascular causes. Primary vascular mechanisms include chronic systemic vascular hypertrophy, focally damaged vessels, a dysplastic lung parenchyma with systemic arterial supply, arteriovenous malformations and fistulas, and bleeding at the capillary level. Evaluating vascular mechanisms of hemoptysis at CT also entails determining if a specific vascular source can be implicated. Although the bronchial arteries are responsible for most cases of hemoptysis, nonbronchial systemic arteries and the pulmonary arteries are important potential sources of hemoptysis that must be recognized. Secondary vascular mechanisms of hemoptysis include processes that directly destroy the lung parenchyma and processes that directly invade the airway. Understanding and employing this approach allow the diagnostic radiologist to interpret CT examinations accurately in patients with hemoptysis and provide information that is best suited to directing subsequent treatment. ©RSNA, 2021.
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Affiliation(s)
- Kaitlin M Marquis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Constantine A Raptis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - M Zak Rajput
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Kacie L Steinbrecher
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Travis S Henry
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Santiago E Rossi
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Daniel D Picus
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
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10
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Koirala A, Thapa A, Mahat S, Sapkota S, Sosa O. A Rare Case of Ruptured Bronchial Artery Pseudoaneurysm and Its Nonsurgical Management With Interventional Techniques. Cureus 2020; 12:e10502. [PMID: 33094045 PMCID: PMC7571596 DOI: 10.7759/cureus.10502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Ruptured bronchial artery pseudoaneurysms with mediastinal hematoma are rare entities with a very limited number of published cases to date. The diagnosis of such cases can be difficult as the patient may present with symptoms mimicking other diseases, mainly mediastinal malignancy. A high degree of clinical suspicion and imaging techniques like contrast-enhanced computed tomography (CECT) chest and computed tomography angiography (CTA) aids in the diagnosis. Under the lights of an interventional radiologist, an urgent endovascular approach is most commonly preferred for its nonsurgical management. We present a rare case of a 47-year-old male with no previous lung disease or trauma with dyspnea and sudden onset chest pain. A massive effusion was suspected on the right side. CECT chest and digital subtraction angiography (DSA) revealed a pseudoaneurysm of a bronchial vessel with associated mediastinal hematoma, collapse of basal right lower lobe, and collection in right pleural space. This patient was later successfully treated by endovascular embolization techniques. Bronchial artery pseudoaneurysm may be considered a remote possibility in the absence of trauma or other lung diseases that may present with a massive hemothorax or mediastinal hematoma. Although CECT can be useful, digital angiography is considered the gold standard. Early intervention with the endovascular approach is a commonly recommended technique.
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Affiliation(s)
- Amrit Koirala
- Interventional Radiologist, Nepal Cancer Hospital and Research Center, Lalitpur, NPL
| | - Ajit Thapa
- Interventional Radiologist, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, NPL
| | - Sanjay Mahat
- Radiology, Nepal Cancer Hospital and Research Center, Lalitpur, NPL
| | | | - Oscar Sosa
- Interventional Radiology, Larkin Community Hospital, Miami, USA
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11
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Rofso Raboso P, García Fernández JL, Moreno Balsalobre R. Bronchial Artery Pseudoaneurysm After Right Upper Lobectomy. An Exceptional Case. Arch Bronconeumol 2018; 55:48. [PMID: 30201177 DOI: 10.1016/j.arbres.2018.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 05/17/2018] [Accepted: 06/09/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Paloma Rofso Raboso
- Servicio de Cirugía Torácica, Hospital Universitario de La Princesa, Madrid, España.
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12
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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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13
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Nguyen DV, Murin S. Bronchial Artery Pseudoaneurysm With Major Hemorrhage After Bronchial Thermoplasty. Chest 2016; 149:e95-7. [PMID: 27055718 DOI: 10.1016/j.chest.2015.09.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 08/19/2015] [Accepted: 09/15/2015] [Indexed: 11/29/2022] Open
Abstract
Bronchial thermoplasty has been found to be a safe and effective therapy for severe asthma. We report the case of a mediastinal hematoma and hemothorax developing in a 66-year-old woman several days after an uneventful bronchial thermoplasty of the right lower lobe. Evaluation revealed a bleeding right bronchial artery pseudoaneurysm. Pseudoaneuryms have been reported in association with other procedures involving the therapeutic application of thermal energy, and a single case of hemoptysis requiring bronchial artery embolization occurred in a clinical trial of bronchial thermoplasty. However, bronchial artery pseudoaneurysm with hemomediastinum and hemothorax has not previously been reported after bronchial thermoplasty.
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Affiliation(s)
- Dan-Vinh Nguyen
- Division of Pulmonary, Critical Care, and Sleep Medicine, UC Davis Medical Center, Sacramento, CA; Sacramento Veterans Affairs Medical Center, Mather, CA
| | - Susan Murin
- Division of Pulmonary, Critical Care, and Sleep Medicine, UC Davis Medical Center, Sacramento, CA; Sacramento Veterans Affairs Medical Center, Mather, CA.
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14
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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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15
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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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