Multiple Enlarged Aneurysms in Primary Racemose Hemangioma of the Bronchial Artery: Successful Prophylactic Transcatheter Arterial Embolization Using N-butyl-2-cyanoacrylate and Coils

Abstract

An asymptomatic 48-year-old man presented with multiple aneurysms in a primary racemose hemangioma of the right bronchial artery. Bronchial arteriography revealed a tortuous artery with four fusiform aneurysms of varying sizes and aneurysmal dilatation with marked thrombus formation in the long segment of the distal portion. Because the tip of catheter could not pass beyond the aneurysmal dilatation, we performed balloon-occluded embolization using a mixture of N-butyl-2-cyanoacrylate (NBCA) and iodized oil. For four other aneurysms, we performed embolization using a coil alone or with NBCA. After 6 months, right bronchial arteriography revealed no enhancement of the aneurysms. Despite the rarity of this procedure, embolization with NBCA is a good option for bronchial artery aneurysm embolization.

Two Cases of Bronchial Artery Racemose Hemangioma Successfully Treated with Bronchial Artery Embolization

“…Gupta et al presented the hypothesis that the bronchial artery may be abnormally hypertrophied when the diameter of the artery is ≥ 2 mm, and/or the course of it is visualized up to the pulmonary hilum on CT 6 . Racemose hemangioma of the bronchial artery is occasionally accompanied by aneurysms, as in Case 1 7 . In addition, vascular hyperplasia, which leads to anastomosis or fistulization to adjacent vessels, such as the pulmonary artery or vein, often coexists, as in our cases 8,9 .…”

“…Materials for BAE are chosen depending on morphology, anatomy, and the degree of hemorrhage. Other than BAE, surgical resection and bronchial arterial ligation are the other available therapies, though these are associated with higher morbidity and mortality rates 7 . Surgical resection can provide definitive treatment without risk of rebleeding even in cases complicated by bronchial artery-pulmonary arterial fistula and collateral circulation, but it is very invasive and decreases pulmonary function.…”

Isolated bronchial hemangioma causing recurrent hemoptysis: A case report

“…The embolism materials for BAE include gelatin sponge, PVA, coils, and N-butyl-2-cyanoacrylate (NBCA). [6] Among them, gelatin sponge is a temporary embolic agent, which is absorbed within 2 to 6 weeks and can make possible the reopening of embolized vessels, and is now less commonly used. PVA, coils and NBCA are permanent embolic agents and are more widely used in BAE.…”

A case of isolated bronchial hemangioma causing recurrent hemoptysis

“…According to a systematic review conducted by Panda, the clinical success rate of BAE is 70-99% [5]. The embolism materials for BAE include gelatin sponge, Polyvinyl Alcohol (PVA), coils, and N-Butyl-2-Cyanoacrylate (NBCA) [6]. Among them, gelatin sponge is a temporary embolic agent, which is absorbed within 2-6 weeks and can make possible the reopening of embolized vessels, and is now less commonly used.…”