A Surgical Case of Bronchial Artery Aneurysm Directory Connecting with Pulmonary Artery

A case of primary racemose hemangioma with endobronchial lesions demonstrating recurrent hemoptysis initially treated with bronchial arterial embolization

Primary racemose hemangioma of the bronchial artery (RHBA) is one of the causes of massive hemoptysis. A 72-year-old woman was admitted to our hospital with recurrent hemoptysis. Bronchoscopy showed an endobronchial lesion, and the angiography of the right bronchial arteries indicated RHBA. Bronchial arterial embolization (BAE) was performed to prevent hemoptysis. Although the endobronchial lesion shrank after the first BAE, the lesion re-increased and caused massive hemoptysis. A thoracoscopic right upper lobectomy was performed, and hemoptysis did not recur. Therefore, in cases of RHBA where there is recurrent hemoptysis and the endobronchial lesions that remain after BAE, additional treatments should be considered.

Thoracoscopic Bronchial Artery Resection for Multiple Bronchial Artery Aneurysms

We describe a 36-year-old asymptomatic female with multiple bronchial artery aneurysms (BAAs) and a bronchial artery (BA) to pulmonary artery (PA) fistula. She was treated with thoracoscopic BA resection without lobectomy in lieu of catheter embolization as first-line treatment. The configuration of the BA and the location of the BAAs were clearly visualized using three-dimensional computed tomography (3DCT); therefore, the segment of the BA to resect was assessed preoperatively and complete resection of all BAAs was performed. Preoperative BA angiography delineated the BA to PA fistula, and guided surgical decision-making.

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

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

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

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

Successful transcatheter arterial embolization in an asymptomatic patient with primary racemose hemangioma of the bronchial artery

An asymptomatic 70-year-old woman presented with a nodular lesion overlapping the pulmonary artery at the right hilar region on a chest X-ray. Bronchial arteriography revealed an aneurysmal dilation of the long segment of the right bronchial artery and a shunt from the right bronchial artery to the right lower pulmonary artery. She was diagnosed with primary racemose hemangioma of the bronchial artery (RHBA). Considering the risk of hemoptysis, we performed a bronchial arterial embolization (BAE) using coils and N-butyl-2-cyanoacrylate. She had no complication after the BAE and no recurrences of hemoptysis at the 36-month follow-up. RHBA should be considered in case of aneurysmal dilation in the long segment of the bronchial artery, and BAE should be considered as a treatment strategy despite the absence of symptoms.

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Primary racemose hemangioma of the bronchial artery (RHBA) has a risk of hemoptysis.

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RHBA should be included in differential diagnosis as a nodular lesion overlapping the pulmonary artery at the hilar region.

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Computed tomography and bronchial arteriography aids in the diagnosis of RHBA.

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Bronchial arterial embolization should be considered in asymptomatic RHBA patients.

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

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.