ENDOVASCULAR BRONCHIAL ARTERY EMBOLIZATION IN LIFE-THREATING HEMOPTYSIS. A CASE REPORT

Abstract

Introduction: Hemorrhage arising from a bronchial arterial source is the most common cause of life-threatening hemoptysis, which is defined as the expectoration of blood originating from the pulmonary parenchyma or the tracheobronchial tree. Significant hemoptysis originates from the bronchial arteries in 90% of cases. It can be acute and can present as medical emergency. Bronchial artery embolization is considered to be the primary and most effective method when confronting a massive hemoptysis. The procedure requires an angiographic study of the anatomy of the bronchial vessels. The artery is reached by a femoral or brachial approach, using a catheter and under fluoroscopic visualization. The embolization may be performed with different agents - particles, gelaspon, coils or glue. Materials and Methods: The case report describes a 9-year-old girl who was admitted with massive hemoptysis. She had to be intubated, with previous anterior and posterior nose tamponade. The girl was admitted with no further complaints or symptoms except the expectoration of blood. Conservative treatment was not effective and after a following attack of massive bleeding she underwent a bronchial artery catheterization. It showed with accuracy the site of hemorrhage to be from the right inferior branch of the vessel, and intra-arterial embolization was performed. Results: The procedure was well tolerated and, as a result, high clinical success was achieved in managing the bleeding. The patient was discharged with no further complications. Conclusion: Bronchial artery embolization is a well-established and well-tolerated procedure. It comes with a better outcome than medical, surgical, or bronchoscopic techniques, especially when facing an acute massive hemoptysis.