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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 3  |  Issue : 3  |  Page : 133-135

A case of bronchial artery aneurysm causing hemoptysis - A rare case report


1 Departments of Respiratory Medicine, Apollo Main Hospitals, Chennai, Tamil Nadu, India
2 Department of Respiratory Medicine, Sundaram Medical Foundation, Chennai, Tamil Nadu, India

Date of Submission15-Mar-2021
Date of Decision16-Mar-2021
Date of Acceptance17-Mar-2021
Date of Web Publication28-Apr-2021

Correspondence Address:
Ria Lawrence
Department of Respiratory Medicine, Apollo Main Hospital, Greams Lane, Chennai - 600 006, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/japt.japt_15_21

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  Abstract 


Hemoptysis is one common presenting complaint in respiratory clinics. Bronchial artery aneurysm is one of the rare causes of hemoptysis. Here, we present a case of a 64-year-old male, asthmatic, and hypertensive with a previous history of tuberculosis presented with hemoptysis. On bronchial angiogram, he was found to have a right bronchial artery aneurysm which was treated with bronchial artery coiling.

Keywords: Bronchial artery aneurysm, bronchial artery embolization, coiling, polyvinyl alcohol, tuberculosis


How to cite this article:
Lawrence R, Sridhar R, Chatterjee P, Ravikumar R, Narasimhan R. A case of bronchial artery aneurysm causing hemoptysis - A rare case report. J Assoc Pulmonologist Tamilnadu 2020;3:133-5

How to cite this URL:
Lawrence R, Sridhar R, Chatterjee P, Ravikumar R, Narasimhan R. A case of bronchial artery aneurysm causing hemoptysis - A rare case report. J Assoc Pulmonologist Tamilnadu [serial online] 2020 [cited 2021 Sep 20];3:133-5. Available from: http://www.japt.com/text.asp?2020/3/3/133/314967




  Introduction Top


Bronchial artery aneurysm (BAA) is seen in <1% of cases of selective bronchial arteriography. It is a potentially life-threatening condition, often requiring immediate therapy following diagnosis. It may be associated with infections, bronchiectasis, or congenital causes. BAA may have varied presentations such as hemothorax or hemoptysis, depending on the location of the aneurysm. Here, we present a case of BAA presented with complaints of hemoptysis.


  Case Report Top


A 64-year-old old gentleman, hypertensive, and asthmatic came to us with complaints of hemoptysis for 15 days. He gave a history of pulmonary tuberculosis 20 years back, which was treated with antitubercular treatment for 6 months, following which he developed bronchiectasis of the left lower lobe with hemoptysis, for which he underwent left lower lobectomy. On examination, he was afebrile, saturating well at room air, and on auscultation, chest was clear. Computed tomography (CT) [Figure 1] scan of the chest showed bilateral bronchiectatic changes with ground-glass opacities. Bronchoscopy was performed which showed no active bleed. Bronchial wash was negative for Gram stain, culture sensitivity, Acid Fast Staining (AFB) stain, and culture. Interventional radiologist team's opinion was sought, and bronchial angiogram [Figure 2] was done which revealed a saccular aneurysm of the right bronchial artery [Figure 3]. The size of the BAA was about 11 mm. He was treated with endovascular coiling [Figure 4] and [Figure 5] of the right bronchial artery and distal polyvinyl alcohol particle embolization [Figure 6]. He had no further episodes of hemoptysis and is on regular follow-up with us.
Figure 1: Bronchial angiogram- Bronchial artery Aneurysm

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Figure 2: Bronchial angiogram- Distal access

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Figure 3: Bronchial angiogram

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Figure 4: Bronchial artery embolization- Distal artery coiling

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Figure 5: Bronchial artery embolization-Proximal artery coiling

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Figure 6: Bronchial artery embolization

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  Discussion Top


The source of bleeding in cases of severe hemoptysis requiring treatment originates 90% from bronchial and 5% from pulmonary arteries.[1] The bronchial arteries usually originate from the proximal descending thoracic aorta. Left bronchial arteries most commonly arise directly from the aorta. Right bronchial arteries occasionally originate directly from the aorta but more commonly share their origin with another artery, typically an intercostal artery.

BAA refers to any form of aneurysmal dilatation involving any segment of the bronchial artery. The normal diameter of the bronchial arteries is smaller than 1.5 mm at the origin and smaller than 0.5 mm more distally. The mean size at presentation is 25 mm (3–121 mm).[2]

The mean age of presentation was 57.9 years (15 days to 89 years). They can be classified as mediastinal, intrapulmonary, or both. In our case, the BAA was intrapulmonary and presented with hemoptysis. The cause of BAAs is unknown; nevertheless, they are associated with bronchiectasis (19.4%), infectious disease (9.3%), atherosclerosis (3.7%), and tuberculosis (3.7%). Moreover, the probable etiology in our case could be past tuberculosis infection or recurrent infections of the bronchiectasis.

BAAs have been reported in about 7% of patients of pulmonary tuberculosis presenting with massive hemoptysis.[3] BAA has also been associated with congenital causes such as pulmonary sequestration or pulmonary agenesis or acquired causes such as atherosclerosis, inflammatory lung disease, bronchiectasis, sarcoidosis, Osler–Weber–Rendu disease, and trauma. Multidetector CT angiography is a noninvasive investigation that enables detailed evaluation of the lung parenchyma, airway, and mediastinum along with the thoracic vasculature in a single study.[4]

There are two main treatment options described, open surgery and an endovascular approach, with similar success rates.[5] Endovascular treatments are divided into selected embolization techniques or aneurysm exclusion by an stent-graft. Multiple materials have been used in the embolization of BAAs: coils, cyanoacrylate, polyvinyl acetate, and gel foam. The use of coils alone or in combination with gel foam, polyvinyl acetate, cyanoacrylate, or Onyx can be done.


  Conclusion Top


BAAs, though rare, are one of the recognized causes of hemoptysis. It requires prompt diagnosis and treatment. An endovascular approach is considered the preferred way of treatment in patients with suitable anatomic features because of its safety, selectivity, efficacy, and low invasiveness.[6]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

We thank the Department of Pulmonology, Radiology, Apollo Hospitals, Chennai, Tamil Nadu, India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Larici AR, Franchi P, Occhipinti M, Contegiacomo A, del Ciello A, Calandriello L, et al. Diagnosis and management of hemoptysis. Diagn Interv Radiol 2014;20:299-309.  Back to cited text no. 1
    
2.
Salamone I, Cavallaro M, Visalli C, Velo M, Barbaro U, Galletta K, et al. Embolization of a bronchial artery aneurysm in a chronic obstructive pulmonary disease (COPD) patient with non-massive hemoptysis. Pol J Radiol 2017;82:174-8.  Back to cited text no. 2
    
3.
Karmakar S, Nath A, Neyaz Z, Lal H, Phadke RV. Bronchial artery aneurysm due to pulmonary tuberculosis: Detection with multidetector computed tomographic angiography. J Clin Imaging Sci 2011;1:26.  Back to cited text no. 3
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4.
Burrill J, Dabbagh Z, Gollub F, Hamady M. Multidetector computed tomographic angiography of the cardiovascular system. Postgrad Med J 2007;83:698-704.  Back to cited text no. 4
    
5.
Zarins CK, Wolf YG, Lee WA, Hill BB, Olcott C IV, Harris EJ, et al. Will endovascular repair replace open surgery for abdominal aortic aneurysm repair? Ann Surg 2000;232:501-7.  Back to cited text no. 5
    
6.
Kasapis C, Gurm HS. Current approach to the diagnosis and treatment of femoral-popliteal arterial disease. A systematic review. Curr Cardiol Rev 2009;5:296-311.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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