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Tomioka Y, Yamada E, Hyodo T, Muro M. Pulmonary ligament rupture due to a bronchial artery aneurysm-induced hematoma: a case report. Surg Case Rep 2024; 10:12. [PMID: 38196023 PMCID: PMC10776544 DOI: 10.1186/s40792-024-01810-3] [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: 10/03/2023] [Accepted: 01/04/2024] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Bronchial artery aneurysm (BAA) is a rare vascular anomaly with the potential for serious complications, such as rupture leading to hemothorax or hemoptysis. Although bronchial artery embolization (BAE) is recognized as an effective intervention for ruptured BAA, video-assisted thoracoscopic surgery (VATS) is a minimally invasive approach for the treatment of associated hemothorax. CASE PRESENTATION A 73-year-old woman presented with a mediastinal hematoma from a ruptured BAA, causing bilateral hemothorax. Emergency angiography revealed a saccular BAA that was successfully embolized using a microcatheter and coil. Subsequent computed tomography revealed an expanding hemothorax managed by VATS, with 1400 mL of blood drained. During VATS, thoracoscopy revealed pulmonary ligament rupture, which was attributed to increased intramediastinal pressure. The patient was discharged eight days postoperatively with no complications. This case highlights the use of BAE and VATS in the management of mediastinal BAA rupture and massive hemothorax. CONCLUSIONS BAE proved to be an effective strategy for the management of ruptured mediastinal BAAs. VATS is a valuable standby procedure for hematoma removal, but the indication should be carefully determined because of the risk of BAA re-rupture.
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Affiliation(s)
- Yasuaki Tomioka
- Division of Thoracic Surgery, Department of Surgery, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan.
| | - Eiji Yamada
- Division of Thoracic Surgery, Department of Surgery, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan
| | - Tsuyoshi Hyodo
- Division of Radiology, Department of Diagnostic Radiology and Interventional Radiology, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan
| | - Masahiko Muro
- Division of Thoracic Surgery, Department of Surgery, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan
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Li X, Zhang H, Ma W, Lv F, Zhou W. Case Report: Combined transcatheter arterial embolization and aortic stent-graft have better efficacy for bronchial artery aneurysms. Front Cardiovasc Med 2024; 10:1328674. [PMID: 38259306 PMCID: PMC10801073 DOI: 10.3389/fcvm.2023.1328674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Bronchial artery aneurysm (BAA) is a rare and fatal condition that requires immediate treatment. However, conventional surgical and transcatheter arterial embolization treatments are less effective. In the present case, a 76-year-old hypertensive woman was admitted with dizziness and diagnosed with an unruptured bronchial artery aneurysm, which was treated by transcatheter arterial embolization and aortic stent-graft. The patient's clinical status was stable during the 4-year follow-up. Simultaneously, we reviewed 79 research papers, analyzing past BAA cases for their etiology, symptoms, and treatment outcomes. We found that catheter arterial embolization and aortic stent-graft implantation, especially for BAA of short-necked and arterial tortuosity, demonstrate superior efficacy compared to other methods. Therefore, we consider this approach to be the preferred choice in clinical BAA treatment.
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Affiliation(s)
- Xiangui Li
- Department of Vascular Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Haoran Zhang
- Queen Mary School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Wenqi Ma
- School of Ophthalmology and Optometry, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Fanzhen Lv
- Department of Vascular Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Weimin Zhou
- Department of Vascular Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
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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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A novel surgical approach for multiple bronchial artery aneurysms. Indian J Thorac Cardiovasc Surg 2023; 39:174-177. [PMID: 36467276 PMCID: PMC9684925 DOI: 10.1007/s12055-022-01436-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 11/25/2022] Open
Abstract
Bronchial artery aneurysms (BAAs) are rare and are known to be associated with bronchiectasis. The presentation varies from incidental radiological finding to life-threatening hemoptysis. A diagnosis of BAA is an indication for intervention irrespective of its presentation. Despite interventional procedures being at the forefront of management, surgical procedures are being reserved for specific situations. Recently, video-assisted thoracoscopic surgery is an alternate for management of BAA. We, herein, present a case of multiple BAA with cystic bronchiectasis managed surgically with left lower lobectomy and localized descending thoracic aorta (DTA) replacement with plication of feeding arteries through left posterolateral thoracotomy approach.
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Abstract
Massive hemoptysis is a highly morbid medical condition with up to 75% mortality with conservative treatment. Bronchial artery embolization has emerged as the common treatment for both acute massive hemoptysis and chronic hemoptysis. This article will review the clinical presentation, bronchial artery anatomy, embolization procedure, complications, and expected outcomes.
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Affiliation(s)
- Claire S. Kaufman
- Dotter Department of Interventional Radiology, Oregon Health & Sciences University, Portland, Oregon
| | - Sharon W. Kwan
- Dotter Department of Interventional Radiology, Oregon Health & Sciences University, Portland, Oregon
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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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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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Video-assisted thoracic resection of a rare ectopic mediastinal bronchial artery aneurysm. Chin Med J (Engl) 2020; 134:857-858. [PMID: 33031139 PMCID: PMC8104245 DOI: 10.1097/cm9.0000000000001157] [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: 11/25/2022] Open
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9
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Ishida S, Koike W, Fujita T, Yagami K. Bronchial artery aneurysm mimicking aortic arch aneurysm or aortic dissection. JTCVS Tech 2020; 3:54-56. [PMID: 34317811 PMCID: PMC8302985 DOI: 10.1016/j.xjtc.2020.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 05/24/2020] [Accepted: 06/16/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Shinichi Ishida
- Department of Cardiac Surgery, Gifu Prefectural Tajimi Hospital, Gifu, Japan
| | - Wataru Koike
- Department of Diagnostic Radiology, Gifu Prefectural Tajimi Hospital, Gifu, Japan
| | - Takashi Fujita
- Department of Cardiac Surgery, Gifu Prefectural Tajimi Hospital, Gifu, Japan
| | - Kei Yagami
- Department of Cardiac Surgery, Gifu Prefectural Tajimi Hospital, Gifu, Japan
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Patel NR, Sidiqi A, Qazi AA, Jaberi A, Forbes TL, Tan KT. Mediastinal bronchial artery aneurysm with short inflow segment successfully treated with a patent ductus arteriosus occluder device. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:93-95. [PMID: 32095664 PMCID: PMC7033448 DOI: 10.1016/j.jvscit.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/16/2019] [Indexed: 01/21/2023]
Abstract
Bronchial artery aneurysm (BAA) is a rare vascular abnormality that may result in life-threatening bleeding if it is left untreated. We present the case of a 35-year-old man with a mediastinal BAA characterized by a short inflow artery segment and tortuous single outflow vessel. The patient's BAA was treated with a novel approach involving placement of a patent ductus arteriosus closure device in the short inflow segment as well as coil embolization of the outflow vessel, successfully excluding the BAA. Two-week follow-up revealed no flow in the embolized artery on computed tomography angiography. This case demonstrates the first successful use of a patent ductus arteriosus occluder device in the treatment of a mediastinal BAA with short inflow segment.
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Affiliation(s)
- Neeral R. Patel
- Interventional Radiology, University Health Network, Toronto, Ontario, Canada
- Correspondence: Neeral R. Patel, MBBS, Interventional Radiology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada M5G 2C4
| | - Abdulwahab Sidiqi
- Interventional Radiology, University Health Network, Toronto, Ontario, Canada
| | - Abdul Aziz Qazi
- Interventional Radiology, University Health Network, Toronto, Ontario, Canada
| | - Arash Jaberi
- Interventional Radiology, University Health Network, Toronto, Ontario, Canada
| | - Thomas L. Forbes
- Vascular Surgery, University Health Network, Toronto, Ontario, Canada
| | - Kong Teng Tan
- Interventional Radiology, University Health Network, Toronto, Ontario, Canada
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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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12
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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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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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