Educational Exhibit Abstract No. 253 - Arterial embolization for massive hemoptysis in patients with chronic lung consolidations

Abstract

Learning Objectives 1). Review the pathophysiology of chronic lung consolidations that result in massive hemoptysis. 2). Discuss the clinical and imaging work-up of patients with massive hemoptysis emphasizing a thorough multidisciplinary evaluation and treatment plan. 3). Review of bronchial artery and non-bronchial systemic arterial anatomy. 4). Highlight embolization techniques and strategies that interventional radiology can offer patients for non-surgical management of massive hemoptysis. Background Chronic lung consolidation results in local hypoxia and vasoconstriction of pulmonary arterioles. This alteration of physiologic blood flow stimulates bronchial artery hypertrophy, vascular tortuosity, and the proliferation of regional systemic arteries most commonly intercostal, internal mammary, and inferior phrenic arteries. Over time these vascular changes may result in life threatening massive hemoptysis and compromise of the airway. Clinical Findings/Procedure Details This exhibit reviews the angiographic evaluation and techniques for embolizing bronchial and non-bronchial systemic arteries in patients with massive hemoptysis secondary to chronic lung consolidation. A variety of embolization materials maybe used and benefits and limitations of each will be discussed. Our exhibit includes quality images to: 1) Demonstrate changes in arterial supply to regions of chronic consolidation, 2) Show variant bronchial artery anatomy, and 3) Review embolization techniques for effective non-surgical treatment. Imaging modalities include radiography, CT, and digital subtraction angiography. Conclusion and/or Teaching Points Life-threatening hemoptysis in patients with chronic lung consolidation is rare, however this can be safely and effectively treated by interventional radiologists. Being aware of changes in arterial vasculature, embolization strategies, and the importance of multidisciplinary evaluation is essential for good patient outcomes.