Allergy and Airway |

Collateral Bronchial Artery Circulation; An Important Differential in Recurrent Hemoptysis in Patients With Previous Thoracic Aortic Aneurysm Repair FREE TO VIEW

Peter Abdelmessieh, DO
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Lenox Hill Hospital, New York, NY

Chest. 2013;144(4_MeetingAbstracts):63A. doi:10.1378/chest.1704973
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SESSION TITLE: Bronchology Student/Resident Case Report Posters

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Patients that present with recurrent hemoptysis after thoracic aneurismal repair should be highly suspected for collateral bronchial artery circulation as a potential cause of persistent pulmonary hemorrhage.

CASE PRESENTATION: Seventy-five year old female presents with a 6 month history of recurrent hemoptysis. Her past medical history is significant for descending thoracic aneurysm repaired with stent, non small cell lung CA s/p left lower lobe (LLL) resection, and aspergillosis infection diagnosed by bronchoscopic biopsy. Hemoptysis continued throughout the admission despite treatment for aspergillosis, and multiple bronchoscopies performed. On day 5 of admission patient developed massive hemoptysis, requiring intubation for airway protection and was transferred to the intensive care unit. Follow up bronchoscopy showed diffuse right lower lobe hemorrhage and oozing from the LLL stump, with no clear source of bleeding. The following day a pulmonary angiogram also failed to show areas of active bleeding. Throughout this time the patient continued to have mild hemoptysis but remained afebrile. On day 10 the patient underwent a bronchial artery angiography, which discovered collateral circulation from the thyrocervical trunk to the right bronchial artery. This was thought to be the source of pulmonary hemorrhage and embolization was performed. Repeat bronchoscopy the following day showed scattered blood clots bilaterally but no active bleeding. Patient was transferred to a regional floor one day later, and discharged to home three days after, with no recurrent episodes of hemoptysis.

DISCUSSION: This case represents the importance of understanding the anatomical variation of the bronchial arteries in the setting of patients with previous endovascular repair and persistent hemoptysis

CONCLUSIONS: Patients that fail to show a clear source of bleeding with routine thoracic angiography and bronchoscopy should have angiographic evaluation of all possible collaterals.

Reference #1: Yoon W, Kim JK, Kim YH, Chung TW, Kang HK. Bronchial and nonbronchial systemic artery embolization for life-threatening hemoptysis: a comprehensive revie. Radiographics. 2002 Nov-Dec;22(6):1395-409. PMID:12432111

DISCLOSURE: The following authors have nothing to disclose: Peter Abdelmessieh

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