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Kawakado K, Yabuki T, Nishi T, Nakanishi M, Makimoto G, Tamura T, Kuyama S. Successful transcatheter arterial embolization of asymptomatic aneurysm associated with left inferior phrenic artery-to-left pulmonary artery fistula: A case report. Respir Med Case Rep 2021; 33:101444. [PMID: 34401284 PMCID: PMC8349102 DOI: 10.1016/j.rmcr.2021.101444] [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: 03/17/2021] [Revised: 04/12/2021] [Accepted: 05/27/2021] [Indexed: 11/25/2022] Open
Abstract
Cases of inferior phrenic artery-to-pulmonary artery fistulas and those complicated by massive hemoptysis have been rarely reported. A 38-year-old man presented to our hospital with a chief complaint of coughing. Computed tomography (CT) revealed a nodule in the left lower lobe, and contrast-enhanced CT showed inflow of contrast medium into the nodule. CT angiography detected an aneurysm associated with a left inferior phrenic artery-to-left pulmonary artery fistula. Transcatheter arterial embolization (TAE) was performed to prevent hemoptysis. Hemoptysis did not occur during the 2-year follow-up. We report a rare case of asymptomatic aneurysm associated with a left inferior phrenic artery-to-left pulmonary artery fistula, which was successfully treated using TAE to prevent hemoptysis.
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Affiliation(s)
- Keita Kawakado
- Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center, 1-1-1 Atago-machi, Iawkuni-City, Yamaguchi, 740-8510, Japan
- Corresponding author. Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center, 1-1-1 Atago-machi, Iwakuni-City, Yamaguchi, 740-8510, Japan.
| | - Takayuki Yabuki
- Department of Radiology, National Hospital Organization Iwakuni Clinical Center, 1-1-1 Atago-machi, Iawkuni-City, Yamaguchi, 740-8510, Japan
| | - Tatsuya Nishi
- Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center, 1-1-1 Atago-machi, Iawkuni-City, Yamaguchi, 740-8510, Japan
| | - Masamoto Nakanishi
- Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center, 1-1-1 Atago-machi, Iawkuni-City, Yamaguchi, 740-8510, Japan
| | - Go Makimoto
- Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center, 1-1-1 Atago-machi, Iawkuni-City, Yamaguchi, 740-8510, Japan
| | - Tomoki Tamura
- Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center, 1-1-1 Atago-machi, Iawkuni-City, Yamaguchi, 740-8510, Japan
| | - Shoichi Kuyama
- Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center, 1-1-1 Atago-machi, Iawkuni-City, Yamaguchi, 740-8510, Japan
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Atchinson PRA, Hatton CJ, Roginski MA, Backer ED, Long B, Lentz SA. The emergency department evaluation and management of massive hemoptysis. Am J Emerg Med 2021; 50:148-155. [PMID: 34365064 DOI: 10.1016/j.ajem.2021.07.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/09/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Massive hemoptysis is a life-threatening emergency that requires rapid evaluation and management. Recognition of this deadly condition, knowledge of the initial resuscitation and diagnostic evaluation, and communication with consultants capable of definitive management are key to successful treatment. OBJECTIVE The objective of this narrative review is to provide an evidence-based review on the management of massive hemoptysis for the emergency clinician. DISCUSSION Rapid diagnosis and management of life-threatening hemoptysis is key to patient survival. The majority of cases arise from the bronchial arterial system, which is under systemic blood pressure. Initial management includes patient and airway stabilization, reversal of coagulopathy, and identification of the source of bleeding using computed tomography angiogram. Bronchial artery embolization with interventional radiology has become the mainstay of treatment; however, unstable patients may require advanced bronchoscopic procedures to treat or temporize while additional information and treatment can be directed at the underlying pathology. CONCLUSION Massive hemoptysis is a life-threatening condition that emergency clinicians must be prepared to manage. Emergency clinicians should focus their management on immediate resuscitation, airway preservation often including intubation and isolation of the non-bleeding lung, and coordination of definitive management with available consultants including interventional radiology, interventional pulmonology, and thoracic surgery.
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Affiliation(s)
- Patricia Ruth A Atchinson
- Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Colman J Hatton
- Dartmouth-Hitchcock Medical Center, Section of Critical Care Medicine, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Matthew A Roginski
- Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Elliot D Backer
- Dartmouth-Hitchcock Medical Center, Section of Critical Care Medicine, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, United States of America
| | - Skyler A Lentz
- Division of Emergency Medicine and Pulmonary Disease and Critical Care Medicine, The University of Vermont Larner College of Medicine, Burlington, VT, United States of America.
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Zied C, Abdessalem H, Ahmed BA, Walid A, Nizar E, Imed F. [Management of massive hemoptysis secondary to pulmonary hydatidosis: Special features]. Rev Mal Respir 2020; 37:518-525. [PMID: 32654939 DOI: 10.1016/j.rmr.2020.06.005] [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: 08/11/2018] [Accepted: 05/26/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Massive hemoptysis is a rare but serious presentation of pulmonary hydatid cysts. The literature reporting this clinical phenomenon is limited to sporadic cases. MATERIAL AND METHODS We undertook a retrospective study considering patients who had undergone lung surgery because of hydatid cyst from January 2000 o December 2015 and examined features associated with massive hemoptysis. RESULTS Among 270 patients operated on for lung hydatidosis, 13 (4.8%) had experienced massive hemoptysis. This sub group had an average age of 24±12 years (13-60 years) and a sex ratio of 0.85. Preoperative embolization was attempted in 5 patients but failed in all cases. All patients with massive hemoptysis were operated on emergency. The origin of bleeding was determined and controlled in all cases (from a vein or an artery from the pulmonary circulation). Pulmonary re-expansion was satisfactory after obliteration of the residual cavity and no pulmonary resection was necessary. The postoperative course was uneventful in 11 patients. Prolonged air-leak beyond 7 days was noted in two patients but settled subsequently with simple follow-up. Average postoperative follow-up was 32 months (8-63 months). One patient (who had hydatid vomit with massive hemoptysis) developed controlateral hydatid recurrence that was also successfully operated on. No recurrence of hemoptysis was noted during the follow-up period for all patients. CONCLUSION Massive haemoptysis secondary to pulmonary hydatidosis may be life-threatening. Surgery of hydatid cysts associated with direct vascular control of eroded vessels is sufficient to control hemoptysis.
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Affiliation(s)
- C Zied
- Service de chirurgie thoracique et cardio vasculaire, CHU Habib-Bourguiba, Sfax, Tunisie.
| | - H Abdessalem
- Service de chirurgie thoracique et cardio vasculaire, CHU Habib-Bourguiba, Sfax, Tunisie
| | - B Ayed Ahmed
- Service de chirurgie thoracique et cardio vasculaire, CHU Habib-Bourguiba, Sfax, Tunisie
| | - A Walid
- Service de chirurgie thoracique et cardio vasculaire, CHU Habib-Bourguiba, Sfax, Tunisie
| | - E Nizar
- Service de chirurgie thoracique et cardio vasculaire, CHU Habib-Bourguiba, Sfax, Tunisie
| | - F Imed
- Service de chirurgie thoracique et cardio vasculaire, CHU Habib-Bourguiba, Sfax, Tunisie
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Seyyedi SR, Sadeghipour P, Sadr M, Shafe O, Moosavi J, Aloosh O, Abedini A, Sharif-Kashani B. Outcomes and Complications of Bronchial Angioembolization in Patients with Massive Hemoptysis. TANAFFOS 2019; 18:310-314. [PMID: 32607111 PMCID: PMC7309885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Massive hemoptysis is a potentially life threatening medical condition and one major problem for both patients and physicians. Choosing the appropriate treatment for the patients is crucial in order to decrease the complications and increase the success rate. Hence, in this study the outcomes and complications of bronchial angioembolization (BAE) were determined in patients with massive hemoptysis. MATERIALS AND METHODS In this prospective cohort, 189 consecutive patients with moderate and severe hemoptysis who had referred to two large cardiovascular centers were enrolled. The Chest X Ray, CT Scan, Fiberoptic Bronchoscopy, Selective and Nonselective Bronchial Angiography were performed in patients. The outcomes with 20-month follow-up were compared. RESULTS The immediate success rate was 97.3%. In 79.7% there were no complications. Temporary chest pain, subintimal dissection, temporary dysphagia, and pancreatitis were seen in 12.3, 2.4, 5.1, and 0.5%, respectively, without any major complication. The in-hospital mortality rate was 1.1% and mortality during 20-month follow-up was 9.6%, and recurrence rate was 28.3% on total. CONCLUSION Our case series showed that BAE is a safe and effective method in treating patients with hemoptysis. Compared to surgery, the procedure is faster and less invasive and might be used both as first line or bridging therapy. Importantly, no major complications have been detected.
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Affiliation(s)
- Seyed Reza Seyyedi
- Lung Transplantation Research Center, Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Makan Sadr
- Virology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Shafe
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jamal Moosavi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Oldooz Aloosh
- Lung Transplantation Research Center, Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Abedini
- Lung Transplantation Research Center, Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Sharif-Kashani
- Lung Transplantation Research Center, Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Correspondence to: Sharif-Kashani B, Address: Lung Transplantation Research Center, Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Email address:
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Yakushiji E, Ota S, Komatsu T, Ayaori M, Ikewaki K. Massive Hemoptysis due to Right Inferior Phrenic Artery-to-Right Pulmonary Artery Fistula in the Right Middle Lobe of the Lung. Intern Med 2017; 56:687-689. [PMID: 28321071 PMCID: PMC5410481 DOI: 10.2169/internalmedicine.56.6783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Massive hemoptysis is a medical emergency and needs immediate treatment. It occurs in a wide variety of pulmonary diseases and typically originates from the bronchial arteries. We herein report a very rare case of a patient bleeding from a right phrenic artery-to-pulmonary artery fistula accompanied with focal bronchiectasis in the right middle lobe of the lung. In this case, multi-detector computed tomography was useful for clarifying the etiology and the abnormal anastomosis and facilitated effective angiographic embolization.
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Affiliation(s)
- Emi Yakushiji
- Department of Neurology and Anti-aging Medicine, National Defense Medical College, Japan
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