Massive hemoptysis due to Mycobacterium fortuitum infection controlled with bronchial artery embolization - a case report

We reported a case of first reported pulmonary infection due to Mycobacterium fortuitum (M. fortuitum) with massive hemoptysis, successfully treated by bronchial artery embolization (BAE). A 78-year-old male was admitted to our hospital complaining of massive hemoptysis. A biochemical examination and DNA/DNA hybridization revealed M. fortuitum in the culture of his sputum. He was treated by BAE, and antituberculous agents and levofloxacin. The patient remains well without recurrence more than one and a half years after the admission.     

叶内型肺隔离症致咯血的栓塞治疗

目的探讨叶内型肺隔离症患者咯血的栓塞治疗效果。方法结合文献复习，回顾性分析6例叶内型肺隔离症患者血管造影表现，并对畸形动脉行栓塞治疗。结果6例叶内型肺隔离症患者血管造影显示畸形动脉7支，表现为粗大、迂曲的体循环血管影；在毛细血管期可见隔离肺叶染色及引流静脉早显；静脉期显示引流静脉（肺静脉）。6例患者均进行畸形血管栓塞治疗，临床止血总有效率100％，随访1a均未复发。结论畸形血管栓塞术对叶内型肺隔离症致咯血的治疗，安全有效。     

Bronchial artery embolization for hemoptysis: Immediate and long-term results

The purpose of this study was to evaluate the immediate and long-term results in 63 patients who underwent transarterial embolization for control of hemoptysis. Overall immediate success rate was 86.1%. At long-term follow-up 50% of patients showed complete remission, 22% partial remission, and 28% recurrent hemoptysis. Hemoptysis remained controlled for a mean of 22 months and a median of 14 months. The long-term results among four disease groups differed substantially. Patients with bronchiectasis showed the best results, followed by those with idiopathic disease and with inflammation; patients with neoplasm showed the worst results.     

Bronchial arteriography and transcatheter embolization in the management of hemoptysis

Purpose The purpose of this study was to determine the factors influencing the effect of bronchial artery embolization in treating massive hemoptysis and the value of bronchial arteriography in the evaluation of patients with hemoptysis.Methods Thirty-five patients with acute hemoptysis were evaluated by means of bronchial arteriography and treated with transcatheter embolization. Specific causes for bleeding were bronchiectasis (17), lung cancer (9), tuberculosis (4), tetralogy of Fallot (1), and idiopathic hemoptysis (4). The materials used for embolization were gelatin sponge in 33 patients, dextran microspheres in 2, and stainless coils in 1.Results The angiographic signs of hemorrhage encountered were extravasation of contrast media (14.2%), hypervascularization (94.5%), bronchopulmonary shunts (34.2%), and bronchial artery aneurysms (14.2%). Immediate control of bleeding occurred in 32 (91.4%) of 35 patients after embolization. The rate of recurrent hemoptysis was 20.0% after 2 weeks of the procedure, but the hemorrhage was less severe than before treatment.Conclusion The data suggest that bronchial artery embolization is an effective method for managing patients with hemoptysis. Minor bleeding recurrences appear to be relatively frequent.     

以咯血为主要表现的肺隔离症1例文献分析

目的分析以咯血为主要表现的肺隔离症,以提高对肺隔离症的认识。方法分析1例以咯血为主要表现的肺隔离症的临床表现、实验室检查结果、影像学资料,并对肺隔离症进行文献复习。结果患者女,51岁,主因间断咳嗽、咯血入院,入院查螺旋CT增强扫描三维重建示异常供血动脉来源于胸主动脉。诊断肺隔离症,建议患者行手术治疗,患者拒绝,经莫西沙星抗感染。云南白药止血等治疗未再咯血并出院。结论肺隔离症是一种少见疾病,临床易于忽视,诊断有赖于螺旋CT增强扫描三维血管重建。手术是本病最佳治疗方法。     

肺结核与支气管扩张症咯血的支气管动脉栓塞治疗

目的 探讨肺结核和支气管扩张症咯血的支气管动脉差异与栓塞方法。方法 临床治疗肺结核咯血25例,支气管扩张症咯血15例,行选择性支气管动脉造影并对病变血管用明胶海绵行栓塞术,32例加用弹簧圈。结果 40例咯血,共对63支有出血征象的动脉行BAE,即时止血率92．5％（37／40）。肺结核咯血以体-肺血管分流多见,支气管扩张症以血管增粗、扭曲多见。结论 肺结核咯血BAE宜注重小血管栓塞,支气管扩张症咯血BAE宜以主干栓塞为主。     

经肺动脉血管内栓塞治疗难治性大咯血

目的 了解经体动脉(SA)栓塞术后无效或合并SA栓塞禁忌证的难治性大咯血的肺动脉(PA)造影表现,评价经PA血管内栓塞治疗的效果.方法 102例接受血管内栓塞治疗咯血患者,6例大咯血者在SA栓塞术后无法即刻止血,1例大咯血者支气管动脉栓塞后无效合并其他SA栓塞禁忌证.7例中原发病为慢性空洞型肺结核3例、慢性空洞型肺结核合并曲菌球1例、结核性支气管扩张1例、重症坏死性肺炎1例和支气管扩张合并肺大疱1例.对其行患侧的主PA造影,对病变部位的PA远端行选择性插管造影,对发现的病理性血管行栓塞治疗,并随访观察临床疗效.结果 SA造影均可见体-肺动脉分流,通过分流发现假性肺动脉瘤(PAPA)2例和PA末梢瘤样扩张2例.主PA造影发现1例PAPA外,其余均表现为病变部位的PA呈低灌注.对6例低灌注的病变部位PA行选择性插管造影发现PAPA 4例,其中1例对比剂直接外溢;PA末梢瘤样扩张2例.对以上病理性血管应用弹簧圈进行栓塞.术后均即刻止血,除1例术后仍有反复痰中带血,2例分别于术后6 d和15 d死于重症感染和呼吸衰竭(期间无咯血),其余患者未再咯血.结论 难治性大咯血需考虑PA出血,PAPA是其主要形式;主PA造影常表现为病变部位的PA低灌注,此时PA选择性插管造影是必要的,且经其行血管内栓塞治疗是有效和安全的.     

Unilateral pulmonary artery agenesis presenting with hemoptysis: Treatment by embolization of systemic collaterals

Systemic-to-pulmonary collateral vessels and shunts develop in patients with isolated unilateral absence of a pulmonary artery (IUAPA). Two cases of IUAPA (right and left) with hemoptysis in adult life are presented. Selective embolization of these systemic vessels controlled hemoptysis successfully. These cases represent an example of an alternative treatment for this rare anomaly.     

Hemoptysis after coil embolization for pulmonary arteriovenous malformation: Histopathological confirmation of bronchial epithelium extension

Coil embolization is widely performed for pulmonary arteriovenous malformations (PAVMs). We describe herein 2 cases of hemoptysis during long-term follow-up after coil embolization for PAVMs. For both cases, lobectomy was performed and histopathological examinations revealed chronic inflammation and bronchial epithelium extension into the sac of the PAVM. In addition, we performed a systematic review of previous reports of hemoptysis after embolization for PAVMs.     

Therapeutic embolization of a systemic arterialization of lung without sequestration

We report the case of a 51-year-old man with massive haemoptysis due to a systemic arterialization of lung without sequestration. Unlike bronchopulmonary sequestration there was a normal bronchial distribution and the involved lung parenchyma was normal. Therefore a therapeutic transarterial embolization of the aberrant systemic vessel from the distal thoracic aorta was performed. The embolization was successful and the patient did not suffer from further haemoptysis during the subsequent follow-up of ten months. A postembolization aortogram 6 months later demonstrated a complete occlusion of the embolized aberrant artery; in the lung perfusion scan there was only a small perfusion defect, but normal ventilation in the embolized basal part of the left lower lobe. Our case represents an alternative treatment to surgery for this rare anomaly. Received 11 February 1997; Revision received 12 May 1997; Accepted 10 June 1997     

超选择性支气管动脉栓塞治疗肺结核大咯血的价值

目的 探讨肺结构大咯血行超选择性支气管动脉栓塞（ＳＢＡＥ）治疗的价值。方法 对４１例肺结构大咯血患者行ＳＢＡＥ,随访４￣５２个月。对复发大咯血患者再次行ＳＢＡＥ治疗。结果 ４１例患者即时止血３５例,即时止血率８５．３％。一次性栓塞治毹６例,治愈率６３．４％。复发１５例,复发率３６．６％,其中日咯血量５００ｍｌ以上患者复发充高于日咯血量５００ｍｌ以下者（Ｐ〈０．０５）;合并有壁空洞和（或）广泛纤维化     

Transcatheter embolization for massive hemoptysis from an intralobar pulmonary sequestration: a case report

Pulmonary sequestration is rarely presented as massive hemoptysis and is conventionally treated by a surgical procedure. Here, we report a case of a 25-year-old man who presented with massive hemoptysis that rapidly developed into a hypovolemic shock. Multidetector computed tomographic angiography showed active contrast extravasation from the aberrant systemic artery originating from the lower descending thoracic aorta. Immediate transcatheter embolization of the aberrant systemic artery was performed successfully. Emergent transcatheter embolization can be an effective method for the management of pulmonary sequestration with life threatening massive hemoptysis.     

膈下动脉参与供血的大咯血的急诊介入治疗

目的探讨膈下动脉（IPA）参与供血的大咯血患者的动脉造影表现及急诊栓塞治疗的疗效。方法回顾性分析15例IPA参与供血的大咯血患者的临床资料。选用明胶海绵条、聚乙烯醇（poly vinylal cohol,PVA）颗粒及弹簧圈选择性栓塞供血的IPA,对动脉造影的表现及治疗结果进行总结及评价。结果选择性IPA造影显示为IPA增粗,分支增多、紊乱及新生血管形成。IPA供血区对比剂外溢10例,肿瘤血管及肿瘤染色3例,IPA与肺动脉分流2例。本组患者均行供血的IPA栓塞术,同时栓塞支气管动脉5支、肋问动脉4支,胸廓内动脉4支,栓塞术后咯血停止。术后随访1～2年,所有患者无再次咯血。结论IPA可参与大咯血的供血,漏栓IPA是栓塞治疗大咯血失败或复发大咯血的原因之一,行急诊IPA栓塞是一种安全、有效的治疗手段。     

Massive hemoptysis two months after an otherwise mild SARS-CoV-2 disease (COVID-19) treated with bronchial artery embolization - A case report

An otherwise healthy young man presented with massive hemoptysis 2 month following a mild coronavirus disease 2019 (COVID-19) and with no other identifiable cause of illness. The patient was successfully treated with bronchial artery embolization. We are strongly convinced that hemoptysis in this case was COVID-related. This unusual case of delayed COVID-related hemoptysis reveals new aspects in the understanding of mid-term and presumable auto-immune triggered effects in patients with initially only mild symptoms of the disease.     

Bronchial artery embolization to control hemoptysis: A review

Bronchial artery embolization has become an established technique in the management of massive or recurrent hemoptysis. The clinical background, methods, and results of this procedure are discussed, as are the potential complications and their prevention.     

经导管弹簧圈栓塞治疗叶内型肺隔离症

目的 探讨经导管弹簧圈栓塞叶内型肺隔离症的安全性和有效性.方法 2000年1月至2012年2月收治13例叶内型肺隔离症患者,造影发现起自胸主动脉下段的异常供血动脉14条,采用经导管弹簧圈栓塞治疗.术后观察疗效及并发症.结果 13例患者的栓塞成功率为100％,无明显并发症发生,术后临床症状好转,均未复发.结论 经导管弹簧圈栓塞治疗叶内型肺隔离症安全、有效.     

支气管动脉栓塞治疗肺结核并大咯血的疗效观察

目的：探讨支气管动脉栓塞治疗肺结核大咯血中的应用价值。方法：33例肺结核大咯血患者经内科保守治疗无效后行支气管动脉栓塞．栓塞材料为明胶海绵颗粒或聚乙烯醇微粒（PVA），栓塞过程在X线影像监视下完成。结果：33例支气管动脉栓塞治疗后，25例1次栓塞后止血；8例2次栓塞后止血，其中5例行支气管动脉和超选择行胸廓内动脉栓塞止血．1例在第二次栓塞后1周因再次大咯血而死亡。结论：支气管动脉栓塞对肺结核大咯血的治疗是一种安全有效而快捷的手段。     

非支气管性体动脉参与供血的大咯血的急诊介入栓塞治疗

目的探讨非支气管性体动脉（NBSA）参与供血的大咯血患者的动脉造影表现及急诊栓塞治疗的疗效。方法回顾性分析36例NBSA参与供血的大咯血患者的临床资料。选用明胶海绵条、聚乙烯醇（polyvinylalcohol,PVA）颗粒及弹簧圈选择性栓塞出血的动脉,对动脉造影的表现及治疗结果进行总结及评价。结果选择性非支气管性体动脉造影显示出血动脉增粗,分支增多、紊乱及新生血管形成。本组中,对比剂外溢有24例,NBSA与支气管动脉分流6例,对比剂外溢合并甲状颈干一支气管动脉分流2例,NBSA与肺动脉分流3例,假性动脉瘤1例。共栓塞42支NBSA,同时支气管动脉12支,栓塞术后48h内咯血停止。术后随访1年,所有患者无再次咯血及严重的并发症。结论NBSA可以参与大咯血的供血,漏栓NBSA是大咯血治疗失败和复发咯血的原因之一,急诊NBSA栓塞是一种安全、有效的治疗手段。     

Recurrent massive hemoptysis from distal pulmonary pseudoaneurysms complicating invasive aspergillosis in a teenager

Invasive pulmonary aspergillosis in children rarely complicates life-threatening massive hemoptysis. Here, we report the case of a 15-year-old girl with acute lymphoblastic leukemia who was hospitalized for fever and medullary aplasia 1 month after beginning chemotherapy for invasive pulmonary aspergillosis. Despite voriconazole and caspofungine treatment, excavation of some lesions caused a unilateral small pneumothorax and bilateral pleural effusion, justifying intensive care management. The massive hemoptysis that occurred on day 23 was complicated with heart failure, and the patient was promptly resuscitated. Fibroscopy and computed tomography angiography (CTA) did not reveal the origin or cause of the bleeding. A second massive bleeding event occurred on day 32, and heart failure resolved after 10min of low flow. A new CTA showed 2 pseudoaneurysms of the subsegmental pulmonary arteries that were treated with embolization. Sedation was gradually decreased owing to improvement in respiratory status, but the patient did not regain consciousness because of deep brain sequelae. A limitation of care was decided upon, and the patient died in the following weeks. Massive hemoptysis is a rare life-threatening complication of invasive pulmonary aspergillosis, especially in children. Pulmonary artery pseudoaneurysms are unusual and should be detected as soon as possible to guide therapy. Intensive care management should be followed by embolization if the patient is stable; otherwise, surgery is indicated, ideally after identifying the source of bleeding by CTA or bronchoscopy. Early CTA follow-up can be proposed if the source of bleeding is still unknown as pseudoaneurysms can appear or grow rapidly.