Endovascular Treatment of Hemoptysis by Abnormal Systemic Pulmonary Artery Supply

Abstract

We report the case of a 29-year-old man with hemoptysis. The patient came to the emergency department, where a laboratory test and chest radiograph were reported as normal. The following day the patient again had hemoptysis, though less than previously. He reported no chest pain, dyspnea, fever, catarrh, changes in urine or feces, contact with patients with bacillus disease or constitutional symptoms. Doppler ultrasound of the chest showed right basal parenchymatous condensation containing a vessel with arterial flow (in the opposite direction to the aortic flow) compatible with an aberrant vessel, possibly a sequestration, leaving the aorta above the celiac trunk. Because of the findings of the chest echogram and magnetic resonance study, thoracoabdominal computed tomography angiography was undertaken; this showed right basal condensation and an anomalous vessel originating 1 cm above the celiac trunk, supplying the right lower lobe. An aortic and pulmonary arteriogram via an arterial and right femoral vein approach confirmed the findings. The patient was treated successfully with percutaneous embolization with coils. The relevant literature is reviewed.

Transarterial Embolization Treatment for Aberrant Systemic Arterial Supply to the Normal Lung: A Case Report and Literature Review

“…Although most patients with ASANL are asymptomatic, the presenting symptoms are cardiac murmur in childhood, and recurrent hemoptysis, dyspnea on exertion, and congestive heart failure in adults (1). Diagnosis is relatively easy with chest computed tomography (CT) (1,2). However, treatment options vary, including surgical resection of the involved lung and surgical ligation of the aberrant artery, and endovascular treatment has been recently introduced (3).…”

Endovascular embolization prior to surgical resection of symptomatic intralobar pulmonary sequestration in an adult

“…Endovascular embolization of intralobar pulmonary sequestration has been reported as a safe alternative to surgery since 1998, but gained wider acceptance mostly as an alternative treatment option in paediatric patients [8] . Data for the endovascular embolization in adult symptomatic patients are sparse [7] , [9] , [10] . Major concerns include possible incomplete occlusion of arterial supply, resulting from distal embolization of feeding vessel with subsequent opening of collateral supply.…”

“…To overcome this problem, preoperative embolization of aberrant systemic arteries with metallic coils or vascular plugs, followed by surgical resection, has recently been proposed [6] . Additionally, the endovascular embolization as a definite therapy of ILS has also been described [7] , [8] , [9] . We present a case of an adult with ILS in whom endovascular embolization using a combination of metallic coils and vascular plugs was performed to allow a safe surgical resection.…”

Anomalous Systemic Arterial Supply to Normal Basal Segment of the Left Lung

“…In adults, the anomalous connection has been predominately treated with lobectomy or surgical ligation of anomalous artery [6,[13][14][15][16]. Lobectomy with ligation of anomalous artery by video assisted thoracoscopic surgery is also described [21].…”