No abstract

Massive haemoptysis is associated with high mortality. Among various diseases presenting with massive haemoptysis, a ruptured bronchial artery aneurysm (BAA) is a rare entity. We report the case of a ruptured BAA as small as 3 mm in diameter associated with massive haemoptysis in a previously healthy 77-year-old woman. She had suddenly developed massive haemoptysis and was intubated and admitted to the intensive care unit. A CT scan and repeated bronchoscopy could not reveal the cause. Because haemorrhage continued, she underwent bronchial arteriography (BAG) twice. We finally detected a BAA with a bleb that led to the diagnosis of a ruptured BAA only 3 mm in diameter. After bronchial artery embolisation, the haemoptysis ceased. Although rare, a ruptured BAA should be considered as a cause of massive haemoptysis. Because a small BAA may get overlooked, close observation is important in BAG.

Surgery for a shaggy aortic aneurysm requires a meticulous strategy to prevent embolic complications since the complications are associated with longer length of hospital stay and higher mortality. However, until now, there are no established treatment options to prevent embolic complications. We report a case of a 75-year-old man with a descending aortic aneurysm and a shaggy aorta who underwent thoracic endovascular aortic repair (TEVAR) with major branch artery protection. During the procedure, we placed balloon catheters in the left subclavian and left common iliac arteries, a filter device in the superior mesenteric artery, and a sheath at the ostium of the right common iliac artery. The patient did not develop embolic or other complications and was discharged on the eighth postoperative day. Our strategy of using the balloon occlusion technique and filter placement at the major vessels effectively prevented embolic complications during TEVAR for a shaggy aorta.

No abstract

A 52-year old woman was referred to our hospital because of abdominal pain and restlessness. A chest contrast-enhanced CT showed huge pericardial effusion and intraluminal defects in the main pulmonary artery. We could not make a diagnosis based on the cytology of the pericardial effusion and histopathology of the mass with a sample taken by a catheter. Therefore, we undertook biopsies of the mass by median sternotomy, which led to the diagnosis of pulmonary intimal sarcoma. The tumor resection was performed to release the right ventricular outflow stenosis. We tried to resect the tumor as much as possible, and reconstructed the pulmonary artery and aortic root. She was discharged to home and survived 5 months after surgery.