SESSION TITLE: Wednesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Bronchial artery embolization (BAE) is a relatively safe and effective treatment for massive hemoptysis. The bronchial and spinal arterial supplies are intricately related and various anatomical variations exist. CASE PRESENTATION: A 57-year-old female presented with progressively worsening hemoptysis after a recent lung biopsy. One week prior to admission, the patient underwent biopsies of a left upper lobe mass as well as suspicious lesions in right middle lobe and right lower lobe. Upon arrival, the patient was intubated for acute hypoxic respiratory failure and underwent emergent 300-500 μm particle embolization of two left lobe branches and one right lobe branch arteries and the bleeding ceased. The patient was deeply sedated and paralyzed for 24 hours after the procedure in an attempt to preserve hemostasis. On day 3, the patient was successfully extubated. Neurological examination after extubation revealed complete paraplegia and impaired pinprick and light touch sensation distal to the T4-T5 level. Magnetic resonance imaging scan of the spinal cord was performed with and without Dotarem® contrast. Abnormal T2/STIR hyperintensity of the ventral cord was noted from levels T1-2 to the mid body of T6 suggestive of acute infarction. Supportive management was instituted including blood pressure augmentation and rehabilitation. DISCUSSION: The bronchial arteries typically originate from the descending thoracic aorta at the level of T5-T6 vertebrae. The ventral and dorsal portions of the spinal cord are supplied by arteries draining into the anterior and posterior spinal arteries respectively. At the thoracic level, anterior radiculomedullary (feeder) arteries anastomose with the anterior spinal artery. These arteries usually originate from the posterior intercostal artery or the intercostobronchial trunk. Rarely, the feeder arteries may arise from the bronchial artery itself. In these patients, particle embolization of bronchial artery may lead to inadvertent embolization of the feeder artery leading to anterior spinal cord infarction. In these patients, embolization can still be performed by advancing the catheter in the bronchial artery distal to the origin of the feeder artery [1]. However, the connection between bronchial and feeder arteries may not be angiographically visible initially but may become apparent as the bronchial artery is embolized. Intermittent angiograms during embolization may help identify these connections [2]. CONCLUSIONS: Anterior spinal cord infarction is a rare complication of BAE. Careful analysis of the vascular anatomy and intermittent angiography during embolization may help prevent this serious complication. Reference #1: Tanaka N, Yamakado K, Murashima S et al. Superselective bronchial artery embolization for hemoptysis with a coaxial microcatheter system. J Vasc Interv Radiol. 1997 Jan-Feb;8(1 Pt 1):65-70. Reference #2: Brown AC, Ray CE. Anterior Spinal Cord Infarction following Bronchial Artery Embolization. Semin Intervent Radiol. 2012 Sep;29(3):241-4. DISCLOSURES: No relevant relationships by Shailesh Balasubramanian, source=Web Response No relevant relationships by Sudhir Krishnan, source=Web Response No relevant relationships by Guramrinder Thind, source=Web Response