Tan Tock Seng Hospital, Singapore, Singapore
Copyright 2016, American College of Chest Physicians. All Rights Reserved.
SESSION TITLE: Student/Resident Case Report Poster - Procedures
SESSION TYPE: Student/Resident Case Report Poster
PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM
INTRODUCTION: Majority of cases of haemoptysis arises from the bronchial artery. Bronchial artery embolization (BAE) remains a life-saving procedure and minimally invasive, hence, serves as the first line of treatment for the most medically compromised patient. Major complications are rare and arise from the unintentional, nontarget embolization, since the bronchial arteries vary considerably in distribution. We present a rare complication post-BAE in a young patient who presented with massive haemoptysis in our Institution.
CASE PRESENTATION: A 28 year old male tourist from Thailand was admitted due to haemoptysis. He had an episode of 150mL haemoptysis, hence CT angiogram with embolization was done. Hypertrophied right intercostobronchial trunk with multiple tortuous vessels supplying the area of consolidation was identified. Supply from the Right internal mammary was also present, hence both vessels were embolized. Hemoptysis subsided after procedure. One hour post-BAE, patient developed vertigo and left-sided weakness. MRI Brain showed new small infarcts in the Right cerebellum and the right hemipons. Patient was referred to physiotherapist and occupational therapist for further rehabilitation. He was discharged with rather good function.
DISCUSSION: Broncho-esophageal fistula, bronchial stenosis, and bronchial necrosis are rare complications post-BAE, as well as posterior circulation stroke. Posterior circulation stroke manifested as vertigo, dysphagia, dysmetria, or cortical blindness, usually happened shortly after procedure, and involved multiple areas in posterior circulation, most commonly cerebellum and brainstem. Most of the cases recover soon with generally good prognosis. Our case reported a young patient with multiple posterior circulation stroke after BAE. The most likely cause may be due to thrombus formation during the procedure. The other possible mechanism would be shunt between bronchial artery and pulmonary vein, as previously speculated.
CONCLUSIONS: Rare complications do occur, hence, comprehensive knowledge about a certain procedure cannot be over emphasized.
Reference #1: Larici, A. R., Franchi, P., Occhipinti, M., Contegiacomo, A., del Ciello, A., Calandriello, L., ... & Bonomo, L. (2014). Diagnosis and management of hemoptysis. Diagnostic and interventional radiology (Ankara, Turkey), (Aprile), N-A.
Reference #2: Chun, J. Y., & Belli, A. M. (2010). Immediate and long-term outcomes of bronchial and non-bronchial systemic artery embolization for the management of haemoptysis. European radiology, 20(3), 558-565.
DISCLOSURE: The following authors have nothing to disclose: Cheila May Coliat, Fang Yu Chang
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