Severe Hemoptysis Research Articles

Outcomes and management of Haemoptysis in the Fontan population

Abstract Background Patients with a Fontan circulation for palliation of a univentricular congenital heart defect commonly possess pulmonary vascular abnormalities including arteriovenous malformations (AVM), aortopulmonary and venous-venous collaterals (1). These vessels are prone to haemorrhage which may result in life-threatening haemoptysis (2). This risk is increased with oral anticoagulant medication, given to reduce the risk of thromboembolism in Fontan patients (3). Management of these patients is difficult, and strategies vary across institutions. Purpose We aim to describe our experience with managing adult Fontan patients presenting with haemoptysis in a tertiary centre with a large Fontan cohort. Methods We retrospectively reviewed the records of 410 adult Fontan patients. Individuals admitted to our institution with an episode of haemoptysis were included. Details relating to anticoagulation regimens, interventions and mortality of patients were captured. Results From a cohort of 410 Fontan patients, 35 haemorrhagic events were observed in 11 patients (2.68%). The median age at initial haemoptysis was 24.5 years (range 19 to 43 years). 6 of the 11 patients were female (54.5%). Haemoptysis recurred in 8 of the 11 patients (72.7%). 2 out of 11 had a prior history of haemoptysis in childhood. All patients were administered with oral vitamin K antagonists at presentation. 24 of the 35 events were managed conservatively with IV fluids, anticoagulation reversal and tranexamic acid (66.7%). 11 events required catheter-based interventions, with coil and/or plug embolization of bleeding vessels. Prior to intervention, CT successfully identified potential bleeding sites in 10 of the 11 events (90.9%) but could not visualise all vessels that were subsequently embolized. The most common culprits for haemoptysis were aortopulmonary collaterals, followed by AVMs and venous-venous collaterals. In severe cases, more extensive management was required including transfusions, bronchoscopy, intubation, surgical exploration (1 patient) and pneumonectomy (1 patient). 3 patients died following recurrent severe haemoptysis (27.3%), and 2 patients died of subsequent Fontan failure and sudden cardiac death respectively. Total mortality of the cohort is 5 out of 11 (45.5%) with a median follow up of 10.75 years (range 3 days to 27 years). Conclusions Haemoptysis is a rare but potentially fatal complication in patients who have undergone a Fontan procedure. The variability in presentation of this condition mandates an individualised approach to management with involvement of a multidisciplinary team. There is a high rate of recurrence following haemoptysis and a comprehensive assessment of all potential bleeding sites is necessary. CT is a useful tool to help facilitate this and guide further management. Our policy is to close all potential sources of bleeding as CT and invasive angiography rarely identifies an active point of bleeding.

Consequences of Disintegrated Care for Dual Tuberculosis and Diabetes in Tanzania: A Case Report on Recurrent Tuberculosis with Severe Haemoptysis in a Patient with Dysregulated Diabetes

Consequences of Disintegrated Care for Dual Tuberculosis and Diabetes in Tanzania: A Case Report on Recurrent Tuberculosis with Severe Haemoptysis in a Patient with Dysregulated Diabetes

Legionella Pneumophila Presenting as a Rare Cause of Acute Thrombocytopenia: A Case Report and Review of Literature.

Legionella pneumophila can cause a wide spectrum of clinical manifestations, ranging from a mild flu-like illness to fulminant multi-organ involvement, characterised by severe pneumonia, diarrhoea, encephalopathy, shock, hepatic dysfunction and renal failure. Very rarely, it can be associated with haematologic conditions such as thrombotic thrombocytopenic purpura (TTP), haemolytic uraemic syndrome (HUS) and immune thrombocytopenic purpura (ITP). We report a rare case of L. pneumophila causing ITP and review previously published cases of thrombocytopenia associated with Legionellosis in the literature. A 53-year-old male presented with fevers, chills, a productive cough and severe haemoptysis. Blood work was remarkable for leukocytosis, severe thrombocytopenia and hyponatraemia. Computed tomography (CT) imaging showed left lower lobe lung consolidation, and a peripheral blood smear showed giant platelets consistent with ITP. Legionella urine antigen testing returned positive. He was treated with intravenous immunoglobin, steroid taper and a ten-day course of azithromycin, which led to normalisation of his platelet count and resolution of the pneumonia. L. pneumophila can lead to complement-mediated destruction of platelets resulting in ITP. Antibodies against L. pneumophila can also cross-react with the enzyme ADAMTS13, inhibiting its function and resulting in TTP and HUS. Additionally, L. pneumophila can infect vascular endothelial cells causing their death and stimulating release of von Willebrand factor (vWF) multimers into the bloodstream, promoting thrombosis and platelet consumption. It is important for internists to consider L. pneumophila in the differential for any patient presenting with pneumonia and severe thrombocytopenia. Earlier detection and intervention can lead to prevention of critical bleeding and better outcomes. Legionella pneumophila is rarely associated with different haematologic disorders resulting in severe bleeding diathesis as well as thrombosis.It is important for internists to consider Legionella pneumophila in the differential diagnosis for any patient presenting with pneumonia and severe thrombocytopenia.Earlier detection and intervention can lead to prevention of critical bleeding and better outcomes.

Prognostic analysis of destroyed-lung patients with preoperative massive hemoptysis: a 20-year retrospective study

BackgroundSurgery is the main treatment option for destroyed-lung (DL) patients with life-threatening massive hemoptysis. However, short-term and long-term surgical safety and efficacy are unclear, prompting this study.MethodsData from 124 DL patients undergoing surgery between November 2001 and January 2022 at Beijing Chest Hospital were retrospectively analyzed. Data of the DL group (82 cases) and DL + massive hemoptysis group (42 cases) were compared with regard to clinical characteristics, long-term postoperative residual lung reinfection.ResultsAs compared with DL group rates, The DL + massive hemoptysis group had greater incidence rates of postoperative complications, invasive postoperative respiratory support, long-term postoperative residual lung reinfection, and postoperative tuberculosis recurrence. Revealed risk factors for postoperative complications (Extent of lung lesion resection), postoperative invasive respiratory therapy (preoperative Hb < 9 g/L, severe intraoperative hemoptysis), and postoperative long-term residual lung reinfection (DL with massive hemoptysis).ConclusionsDL patients with massive hemoptysis had greater rate of invasive respiratory support therapy and postoperative complications. Extensive lesion removal, preoperative anaemia, severe intraoperative bleeding associated with recent postoperative complications for the patient.

Frightening symptom hemoptysis: Analysis of etiology, mortality, and treatment outcomes in a large cohort from the chest disease center in Turkiye

Aims: Hemoptysis can indicate serious, potentially life-threatening conditions. The etiology varies by region and can include tuberculosis (TB) in developing countries and malignancies in developed regions. Methods: This retrospective cohort study reviewed medical records of 400 hospitalized hemoptysis patients between June 2012 and March 2016. Data collected included patient demographics, comorbidities, hemoptysis volume, diagnostic tests, treatments, and outcomes. Survival rates and readmissions were tracked for 2-6 years post-discharge. Results: Of the 400 patients, 88 (22%) were female and 312 (78%) were male. The leading causes of hemoptysis were bronchiectasis (14%), sequela of tuberculosis (TB sequelae; 19%), and malignancy (22.8%). The most common causes in male patients were lung cancer (27.2%) and TB sequelae (21.8%). Bronchiectasis accounted for 28.4% of cases in female patients, followed by drug-induced hemoptysis at 14.8%. The in-hospital mortality rate was 1% (n = 4), with severe hemoptysis present in all four patients who died during admission for hemoptysis. The 2–6-year survival rate was 70.8% for women and 56.1% for men (p = 0.005). The factors found to significantly worsen mortality risk were lung malignancy, age &gt;65, diabetes, and chronic obstructive pulmonary disease (COPD). Conclusion: Overall, lung cancer was found to be the leading cause of hemoptysis, with bronchiectasis being the leading cause in female patients and malignancy in male patients. Close monitoring of male patients is crucial due to higher mortality risk. Careful assessment of patients with hemoptysis having comorbidities such as diabetes and COPD is required due to the reduced survival rates associated with these conditions. Early detection and intervention for lung cancer is essential to optimize the prognosis of affected individuals.

Feasibility of revascularization after gelatin sponge embolization for hemoptysis during balloon pulmonary angioplasty

BackgroundVessel injury is a common complication during balloon pulmonary angioplasty (BPA). For persistent hemoptysis, gelatin sponge embolization (GSE) is considered, but its impact on subsequent perfusion in embolized vessels remains unknown. This study explores the feasibility of revascularization in vessels post-GSE. MethodsWe included 64 vessels from 50 patients with chronic thromboembolic pulmonary hypertension who experienced hemoptysis during BPA in 2012–2023. Twenty-four vessels were treated conservatively (conservative group), while 40 were treated with GSE for persistent hemoptysis or desaturation despite conservative treatment (GSE group). We assessed hemoptysis-related parameters, perfusion of injured vessels pre- and post-treatment, and hemodynamic parameters through multiple BPA sessions. ResultsHemoptysis resolved immediately after the procedure in 67% of patients, including 70% of those in the GSE group, and all cases resolved by the next day. Of 37 embolized vessels, 41% showed spontaneous perfusion improvement in subsequent sessions. BPA was reperformed in 22 embolized vessels, with 86% showing further improvement, resulting in 70% of all embolized vessels finally showing improvement in perfusion. In both groups, clinical and hemodynamic parameters significantly improved after BPA. ConclusionsPerfusion of embolized vessels improved after GSE, suggesting that GSE is safe for the treatment of severe persistent hemoptysis after conservative treatment.

Rare case of massive middle cerebral artery infarct after bronchial artery embolisation

Bronchial artery embolization (BAE) is a procedure that aims to control bleeding from bronchial arteries in massive and chronic haemoptysis. It is considered to be a life-saving measure in severe life-threating haemoptysis. Although it is minimally invasive and has a high success rate, it still carries a list of complications. These include post-embolisation syndrome, chest pain, back pain, dysphagia, vascular injury at the site of the embolisation leading to dissection, perforation, pseudoaneurysm and, very rarely, embolic infarction to non-target vessels. Stroke is one of the rare complications post BAE, and it can be severe and fatal. Few cases of stroke post BAE have been reported in the literature, and they were mainly due to posterior cerebral circulation infarction. Here, we report a case of a stroke post BAE due to massive middle cerebral artery (MCA) infarction and to our knowledge it seems to be the first reported case of MCA infarction post BAE. The discussion will cover the possible mechanisms of embolic passage, the outcome of the case including rehabilitation perspectives and the learning points. These will also highlight the importance of early recognition, which can save patients from a disabling stroke in the future.

Destroyed lung contributes to the recurrence of hemoptysis after bronchial artery embolization in patients with post-tuberculosis bronchiectasis

BackgroundBronchiectasis has high rates of hemoptysis and recurrent hemoptysis, which is inconsistent among various etiologies. Idiopathic bronchiectasis and post-tuberculous bronchiectasis are two important etiologies in China, but the differences in clinical features and risk factors of recurrent hemoptysis have not been elucidated. MethodsPatients hospitalized for idiopathic bronchiectasis or post-tuberculosis bronchiectasis were included. Patients were followed up for at least 24 months post-BAE. Demographic characteristics and clinical data were collected and analyzed between idiopathic bronchiectasis and post-tuberculosis bronchiectasis. Based on the outcomes of recurrent severe hemoptysis in patients with post-tuberculosis bronchiectasis, Cox regression models were used to identify risk factors for recurrence. ResultsAmong 417 patients including 352 idiopathic bronchiectasis and 65 post-tuberculous bronchiectasis, 209 (50.1%) were females. Compared with the idiopathic group, the proportion of patients with female (54.5% vs. 26.2%, p < 0.001), with sputum (79.5% vs. 36.9%, p < 0.001), isolation of Pseudomonas aeruginosa (28.7% vs. 7.7%, p < 0.001), and the number of bronchiectatic lobes≥ 3(98.3% vs 50.8%, p < 0.001) were lower, and the proportion of destroyed lung (4.5% vs. 26.6%, p < 0.001) and recurrence of severe hemoptysis (22.4% vs. 41.5%, p = 0.001) were higher in the post-tuberculous group. Among patients with post-tuberculosis bronchiectasis, destroyed lung [HR: 3.2(1.1,9.1), p = 0.026] and abnormal esophageal proper artery [HR: 2.8(1.1,7.0), p = 0.032] were two independent risk factors for the recurrence of hemoptysis. ConclusionsThe recurrence rate of severe hemoptysis in patients with post-tuberculous bronchiectasis receiving BAE is high, and the proper esophageal artery should be actively evaluated and standardized treatment should be given.

Extralobar pulmonary sequestration in an adult male with a heart defect. Case report

Pulmonary sequestration (PS) is a rare congenital malformation of the lungs referring to an abnormal (non-functioning) segment of the lung that has no connection with the tracheobronchial tree, which receives arterial blood from systemic circulation and has various types of venous outflow. PS is divided into intralobar (intrapulmonary) and extralobar (extrapulmonary) types. The distinctive feature of extralobar pulmonary sequestration is the presence of its own visceral pleura. PS is most common in pediatric practice; in some cases, this disease may remain oligosymptomatic or asymptomatic in children and adolescents. Adults with PS have a higher risk of recurrent pneumonia, chest pain, and episodes of hemoptysis. Cases of the late onset of PS are reported in a few foreign and Russian publications. The special feature was the elderly patients with a long asymptomatic course of PS, "pseudopneumonic" clinical onset, episodes of thoracalgia and hemoptysis. We present a case of an adult male soldier with PS clinically simulated a respiratory infection in the lower lobe of the left lung with severe pain and hemoptysis. In addition, the patient has a concomitant congenital heart defect.

Bronchiectasis with Trans Mediastinal Herniation of Left Upper Lobe in 3-Year-Old Child: A Case Report

BACKGROUND: Bronchiectasis is a disorder characterized by destruction of smooth muscle and elastic tissue due to inflammation which leads to permanent dilation of bronchi and bronchioles. It may develop in association with Cystic Fibrosis, a single severe episode or recurrent episodes of pneumonia and exposure to tuberculosis. The principal conditions associated with bronchiectasis are obstruction and infection. Infections primarily originate from issues with airway clearance, which cause bronchi and bronchioles to enlarge irreversibly. Vertical airways are notably affected, while distal bronchi and bronchioles are more severely affected. The degree of disease activity and chronicity may affect the histological findings. Childhood bronchiectasis can proceed to severe consequences including persistent bacterial bronchitis, in developing nations like India due to a lack of effective diagnosis and treatment as a result of poor health care infrastructure in the rural areas as well as limited awareness on the part of general public and health care professionals. THE CASE: A 3.5-year-old Indian boy presented with productive cough and cold for 8 days associated with low grade fever. Patient was admitted through Out Patient Department (OPD) due to respiratory distress and facial swelling. Clinical exam revealed presence of crepitation, wheeze and pectus carinatum. Patient has history of multiple hospital admissions due to pneumonia and respiratory distress. There is history of exposure to tuberculosis. His mother had been diagnosed with tuberculosis when the child was 3 months old. She received anti-tubercular drugs and is now cured. HRCT thorax reveals collapse of basal segment of right lung, trans-mediastinal space shift of left upper lobe and bi-lateral bronchiectatic changes which include unusually thickened enlarged airways exhibiting the characteristic tram-track appearance. Echocardiogram findings show thickened pericardium, mild pericardial collection and trace tricuspid valve regurgitation. The case is unique since it is quite rare for a young child to have such a severe form of bronchiectasis. CONCLUSION: Diagnosis can be done with the help of radiological and clinical examination. However, High Resolution Computed Tomography (HRCT) scan is the investigation of choice. Early management is a key factor in minimizing more serious complication like severe hemoptysis and cor pulmonale. Current treatment modalities include antibiotics, bronchodilators, anti-inflammatory drugs and chest physical therapy. Severe cases may require injectable antibiotics. Bronchiectasis was thought to be an orphan disease that seldom progressed to severe consequences, especially after the introduction of newer antimicrobials. There exist guidelines that advocate treatments for bronchiectasis, and reports of therapy have been shown to be linked with clinical success. However, such guidelines do not exist in India at present. This case is noteworthy as it portrays bronchiectasis in an Indian child that has proceeded to the severe complication of transmediastinal herniation, demonstrating that it is relatively common albeit under-diagnosed in developing countries. Though is an irreversible disease in adults, in children if detected early there is almost complete restoration of pulmonary function and adequate exercise tolerance. Early diagnosis with suitable pharmacological and non-pharmacological management is critical for a positive outcome and prevention of sequelae like persistent bacterial bronchitis.

Etiology, diagnostic modalities, and short-term outcomes of hemoptysis-a retrospective cross-sectional study from a tertiary care center in Qatar.

Hemoptysis is a concerning symptom characterized by the expectoration of blood from the respiratory tract, which can range from mild to life-threatening. It can be caused by various underlying conditions. Accurate diagnosis is critical for effective management. The causes of hemoptysis can vary depending on geographic location and the population's composition. In this study, we aimed to examine the etiology, diagnostic methods, and short-term outcomes of hemoptysis in Qatar, focusing on data from Hamad General Hospital (HGH), which serves as a major tertiary care center in the country. Qatar has a diverse and dynamic population, primarily composed of expatriate workers, especially from South Asia. Previous data on hemoptysis in Qatar was collected between 1997 and 2007, when the population was considerably smaller and less diverse. Given the substantial growth in population and diversity since then, this study sought to provide updated information on the causes and outcomes of hemoptysis in the region. This is a retrospective single center observational data review from the largest tertiary care center of Qatar, HGH. Patients who presented to HGH from 01/07/2015 to 30/06/2018 with hemoptysis were included in the study. Descriptive and summary statistics were described and analyzed using SPSS version 23. A total of 172 patients met the inclusion criteria. Most of the patients were male (74.4%) with a mean age of 37.9±16.4 years. South Asians (43.6%) accounted for the majority followed by Qatari nationals (20.3%). Mild hemoptysis was recorded in 89.5% of patients while only 3.5% had severe hemoptysis. The mean duration of hemoptysis was 1.72±0.72 days. The most common etiology was respiratory infection in 72.6% of the patients followed by tuberculosis (TB) and bronchiectasis 7% each. All patients were managed with observation or antimicrobials except two of the patients with severe hemoptysis who required bronchial artery embolization (BAE). There were no reports of recurrence of hemoptysis or deaths until hospital discharge. Respiratory infection is the most common cause of hemoptysis at our center. Mild hemoptysis is the major presentation and the majority improved with conservative treatment.

Safety and local efficacy of computed tomography-guided microwave ablation for treating early-stage non-small cell lung cancer adjacent to bronchovascular bundles.

To retrospectively evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous microwave ablation in treating early-stage non-small cell lung cancer (NSCLC) adjacent to bronchovascular bundles. Two hundred and thirty-one patients with early-stage NSCLC who underwent CT-guided microwave ablation of the tumor were included for analysis. Among these, 66 lesions were located adjacent to the bronchovascular bundle. Achievement of the specific ablation range (defined as the ablation zone encompassing the tumor and the adjacent vessel) was assessed after ablation. Complications and tumor progression after treatment were examined and compared between the bronchovascular bundle and non-bronchovascular bundle groups. A total of 231 patients were included. Overall, 1-, 2-, and 3-year local progression-free survival (LPFS) was 77.4%, 70.5%, and 63.8%, respectively. Bronchovascular bundle proximity, pure-solid tumor, tumor size, and ablation margin < 5mm were independent risk factors for local progression in multivariate analysis. In the bronchovascular bundle group, the 1-, 2- and 3-year LPFS rates were 63.0%, 50.7%, and 43.4%, respectively; vessel proximity and specific ablation range failure were independent risk factors for local progression. Overall survival in the entire cohort was 93.0% at 1year, 76.1% at 2years, and 55.0% at 3years. The incidence of postoperative complications did not significantly differ between the two groups (p > 0.05). The most common complication was pneumothorax. Severe hemoptysis did not occur. Tumor location near the bronchovascular bundles was a significant risk factor for local progression after microwave ablation. Achieving a specific ablation range may increase LPFS for these lesions. Achieving the specific ablation range may improve local efficacy for early-stage non-small cell lung cancer located adjacent to the bronchovascular bundle. • Local efficacy of percutaneous microwave ablation in treating early-stage non-small cell lung cancer was affected by bronchovascular bundle proximity. • Achieving the specific ablation range may improve local efficacy for lesions located adjacent to the bronchovascular bundle.

Open after endovascular repair for previous extra anatomic bypass of adult coarctation.

During follow-up, aneurysm formation in adults with coarctation of aorta has been reported after undergoing extra-anatomical aortic bypass grafting. Endovascular repair was a reasonable treatment option but there were still complications. A 48-year-old male who underwent extra-anatomical aortic bypass grafting, presented with severe back pain and hemoptysis. He had a diagnosed pseudoaneurysm with concealed rupture at the bypass grafting. He underwent endovascular repair and coil embolization. A postsurgical CT-angiogram showed there was extravasation from stent into the pseudoaneurysm. An open repair with endovascular stent removal instead of restenting was performed.

Clinical Insight on Warfarin Induced Diffuse Alveolar Haemorrhage: A Case Report

Background: Diffuse alveolar haemorrhage (DAH) is a serious condition which requires a medical emergency. A contributing factor to DAH is anticoagulant treatment. Warfarin has been used as prophylaxis and treatment of venous thrombosis, thromboembolic complications from atrial fibrillation or cardiac valve replacement. Warfarin-induced diffuse alveolar haemorrhage is a serious medical condition. Initially, the diagnosis of DAH and for other pulmonary conditions clinical presentation and chest X-ray were enough to suggest the diagnosis.&#x0D; Case Report: In this report a 72-year-old female patient with a history of Coronary Artery Disease (CAD), Hypertension, and surgical procedure of Aortic Valve Replacement (AVR) and Percutaneous Transluminal Coronary Angioplasty (PTCA). She was on warfarin therapy for 5 years and was admitted to the hospital for severe cough, haemoptysis and dyspnoea. DAH was suspected clinically and confirmed by Computed Tomography (CT) chest and bronchoscopy. The patient required treatment with non-invasive ventilation and fresh frozen plasma and other supportive care. Early diagnosis and treatment are highlighted in our case and an anticoagulation reversal is required. Therefore, it is important to carefully monitor patients receiving warfarin therapy for the main symptoms of such an incident and to start treatment as soon as possible in order to reduce mortality.

Pseudomonas aeruginosa isolation is an important predictor for recurrent hemoptysis after bronchial artery embolization in patients with idiopathic bronchiectasis: a multicenter cohort study

BackgroundNearly half of bronchiectasis patients receiving bronchial artery embolization (BAE) still have recurrent hemoptysis, which may be life-threatening. Worse still, the underlying risk factors of recurrence remain unknown.MethodsA retrospective cohort was conducted of patients with idiopathic bronchiectasis who received BAE from 2015 to 2019 at eight centers. Patients were followed up for at least 24 months post BAE. Based on the outcomes of recurrent hemoptysis and recurrent severe hemoptysis, a Cox regression model was used to identify risk factors for recurrence.ResultsA total of 588 individuals were included. The median follow-up period was 34.0 months (interquartile range: 24.3–53.3 months). The 1-month, 1-year, 2-year, and 5-year cumulative recurrent hemoptysis-free rates were 87.2%, 67.5%, 57.6%, and 49.4%, respectively. The following factors were relative to recurrent hemoptysis: 24-h sputum volume (hazard ratio [HR] = 1.99 [95% confidence interval [95% CI]: 1.25–3.15, p = 0.015]), isolation of Pseudomonas aeruginosa (HR = 1.50 [95% CI: 1.13–2.00, p = 0.003]), extensive bronchiectasis (HR = 2.00 [95% CI: 1.29–3.09, p = 0.002]), and aberrant bronchial arteries (AbBAs) (HR = 1.45 [95% CI: 1.09–1.93, p = 0.014]). The area under the receiver operating characteristic curve of the nomogram was 0.728 [95% CI: 0.688–0.769].ConclusionsIsolation of Pseudomonas aeruginosa is an important independent predictor of recurrent hemoptysis. The clearance of Pseudomonas aeruginosa might effectively reduce the hemoptysis recurrence rate.

Coil embolization of a pulmonary artery-bronchial fistula associated with intra parenchymal pseudoaneurysm, endovascular approach, and bronchoscopy monitoring – A case report

A 62-year-old man with a heavy background of the right upper lobe squamous cell carcinoma was admitted with massive hemoptysis. Computerized tomography (CT) showed a large right upper lobe lesion with infiltration of mediastinum and airways. A right pulmonary artery pseudoaneurysm slightly bulging into the right main bronchus was seen, suspicious for a pulmonary artery bronchial fistula. A combined endotracheal and angiographic approach was done. The right pulmonary artery angiogram showed a now occluded neck to the pseudoaneurysm which was selectively cannulated. Framing and packing coils were deployed. Contrast was endoscopically noted without bronchial bleeding. As the coils were entering the lung parenchyma, packing back to the neck was done carefully. No new bleeding was noted. A bronchial stent was inserted 6 weeks later and one coil protruding into the bronchus was seen. A 3 month CT follow-up did not show any residual pseudoaneurysm. Patient died 3 months after initial procedure of his progressive illness. Only three cases of endovascular management of bronchial-pulmonary artery fistula reported with different techniques including pulmonary artery stenting. Our case is the only one reported treated with only coil embolization. Limited data are available regarding the risk of pulmonary embolism after stenting. Anticoagulation required after stenting increases the risk of bleeding in patients with severe hemoptysis. Management with coils only facilitates further management. This preserves pulmonary circulation in patients with already compromised respiratory function. Coil only embolization of uncommon pulmonary artery bronchial fistula is feasible and facilitates further management as it does not require anticoagulation in patient with recurrent bleeding.

Surgical management of pulmonary aspergilloma

: Pulmonary aspergillomas occur due to the aspergillus fungus colonising pre-existing cavities within the lungs of patients with underlying lung pathology or in those who are immunosuppressed. Their clinical presentation can be variable and they often present to the surgical clinic after patients develop haemoptysis. This haemoptysis can vary from mild bleeds to catastrophic life-threatening haemorrhage. Surgery for patients with aspergillomas historically carried a high morbidity and mortality impact and so the role of surgery was usually saved for patients presenting with severe haemoptysis. In recent years further research has demonstrated a reduction in the morbidity and mortality impact of surgery and therefore the question has been raised whether surgical intervention should be offered at an earlier stage. Surgery for pulmonary aspergilloma is technically challenging and does still carry a marked morbidity and mortality risk. Although these risks have reduced in recent years, surgery should still be reserved for symptomatic patients with a significant risk of further bleeding. A multi-disciplinary framework is crucial to offer best risk; benefit assessment and discussion for this high-risk patient group. This article will describe the natural history and presentations of aspergillomas, the indications and types of surgery as well as a multi-disciplinary approach to patient assessment.

Bronchial Artery Embolization in Management of Hemoptysis in a Developing Country: An Initial Experience

Abstract Objectives This article evaluates the immediate success, recurrence rate, complications, and the culprit vessel of bronchial artery embolization (BAE) in patients presenting with hemoptysis. Materials and Methods All patients who underwent BAE from July 1, 2018 to August 31, 2021 were included. BAE was done for moderate to severe hemoptysis or for mild hemoptysis which was recurrent and not controlled by medical management. Patients referred for surgical intervention and hemoptysis controlled on medical management were excluded. Results One hundred and thirty patients underwent BAE in the study period. Mean age was 41.5 years and majority (73.1%) was male. Forty-three (33.1%) patients had mild, 46 (35.4%) had moderate, and 41 (31.5%) with the duration of symptoms ranging from 3 days to 25 years. Most common culprit vessel was posterior intercostal artery closely followed by the intercostobronchial artery. Hypervascularity was the most common angiographic abnormality encountered. On an average, 2.75 vessels were embolized per BAE with a wide range of 1 to 8 vessels. Hemoptysis control was seen in 96.1% patients immediately, 90.7 % at 1 month, 82.3 % at 3 months, and 66.9 % at 6 months. Overall recurrence was seen in 43 patients (33.1%). Chest pain was the most common minor side effect occurring in 77.1% cases. Conclusion BAE is a safe and effective procedure that can be performed routinely in patients presenting with moderate to massive hemoptysis or with mild hemoptysis refractory to medical management.

Massive Hemoptysis and Pulmonary Thromboembolism in a Patient with Pulmonary Tuberculosis: A Therapeutic Conundrum Managed with Bronchial Artery Embolization

Hemoptysis is a crucial entity taking into account its morbidity and mortality. Pulmonary tuberculosis is the leading cause for massive hemoptysis in our part of the world, which if left untreated may be life threatening. We present a case of a 37-year-old male patient with pulmonary tuberculosis with concurrent pulmonary thromboembolism presenting with massive hemoptysis, which was successfully managed with Bronchial Artery Embolization. This case represents that this measure can be a viable therapeutic choice for a patient with a severe life-threatening hemoptysis, particularly when other treatment options are unavailable or ineffective.

Behçet's Disease: A Radiological Review of Vascular and Parenchymal Pulmonary Involvement.

Behcet's disease (BD) is a chronic systemic inflammatory disorder characterized by underlying chronic vasculitis of both large- and small-caliber vessels. Thoracic involvement in BD can occur with various types of manifestations, which can be detected with contrast-enhanced MSCT scanning. In addition, MR can be useful in diagnosis. Characteristic features are aneurysms of the pulmonary arteries that can cause severe hemoptysis and SVC thrombosis that manifests as SVC syndrome. Other manifestations are aortic and bronchial artery aneurysms, alveolar hemorrhage, pulmonary infarction, and rarely pleural effusion. Achieving the right diagnosis of these manifestations is important for setting the correct therapy and improving the patient's outcome.