Abstract:We present the case of a 59-year-old male with massive hemoptysis secondary to a bronchopulmonary artery fistula formed as the result of a perihilar lung cancer. The hemoptysis was successfully treated by Amplatzer Plug (St. Jude Medical) embolization of the supplying pulmonary artery branch. At the same time, bronchoscopy was performed to tamponade the patients bleeding and avoid exsanguination. Biopsy of the mass demonstrated poorly differentiated non small cell carcinoma. Post procedure day 13 the patient u… Show more
“…Plugs were used in two cases, in one case the entire right main pulmonary artery was embolized while in the second case the right lower lobe pulmonary artery was embolized. In the first case, the patient remained hemoptysis free during the reported follow up period of 6 months, and in the latter the patient was discharged on day 4 post-op without a reported longer follow up [14 , 15] .…”
Section: Discussionmentioning
confidence: 96%
“…4 ). These interventions have shown to prolong survival in these otherwise fatal cases [11] , [12] , [13] , [14] , [15] . Fig.…”
“…Plugs were used in two cases, in one case the entire right main pulmonary artery was embolized while in the second case the right lower lobe pulmonary artery was embolized. In the first case, the patient remained hemoptysis free during the reported follow up period of 6 months, and in the latter the patient was discharged on day 4 post-op without a reported longer follow up [14 , 15] .…”
Section: Discussionmentioning
confidence: 96%
“…4 ). These interventions have shown to prolong survival in these otherwise fatal cases [11] , [12] , [13] , [14] , [15] . Fig.…”
“…Only three cases of endovascular management of bronchialpulmonary artery fistula have been reported previously; occlusion of pulmonary artery with Amplatzer vascular plug (Abbott, Illinois, USA), stent graft placement in pulmonary artery, and bare stent and coil and N-butyl cyanoacrylate. [3][4][5] is case is the only one to report treatment with only coil embolization with concomitant bronchial endoscopy. e alternative to this is pulmonary artery stenting, however, there is currently no long-term data about the outcome of pulmonary artery stents, either bare or covered.…”
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.
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