Author:
Morimura Fumio,Hamamoto Kohei,Edo Hiromi,Ishida Osamu,Tsustsumi Koji,Tamada Soichiro,Kuwamura Hiroshi,Enjoji Yasuhiro,Suyama Yohsuke,Sugiura Hiroaki,Watanabe Sadahiro,Ozaki Ippei,Shinmoto Hiroshi
Abstract
Abstract
Background
Massive hemoptysis after thoracic aortic aneurysm (TAA) repair is a rare but potentially lethal condition. Endovascular management is a challenging treatment option due to the complexity of culprit vessel access.
Case presentation
An 81-year-old woman was referred to our hospital with massive hemoptysis. She had a history of graft replacement and thoracic endovascular aortic repair (TEVAR) for dissecting TAA. Computed tomography (CT) showed massive atelectasis with hematoma in the left lower lung lobe adjacent to the descending aortic aneurysm treated with TEVAR. Contrast-enhanced CT revealed a pseudoaneurysm and proliferation of abnormal vessels at the peripheral side of the left pulmonary ligament artery (PLA) in the atelectasis. The PLA continued to the right subscapular artery via a complex collateral pathway. Diagnostic angiography of the right subcapsular artery revealed a pseudoaneurysm and abnormal vessels at the peripheral side of the left PLA with a systemic-pulmonary artery shunt. Transcatheter arterial embolization (TAE) for the left PLA via the collateral pathway with N-butyl cyanoacrylate achieved complete embolization. The patient’s hemoptysis was controlled and she was discharged.
Conclusions
Here we presented a case of massive hemoptysis due to PLA disruption that occurred after TAA repair. TAE via a complex collateral pathway is a feasible and effective treatment for hemoptysis, even in patients who have undergone surgical or endovascular TAA repair.
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine,Radiology, Nuclear Medicine and imaging
Reference22 articles.
1. Chun JY, Morgan R, Belli AM (2010a) Radiological management of hemoptysis: a comprehensive review of diagnostic imaging and bronchial arterial embolization. Cardiovasc Interv Radiol 33(2):240–250. https://doi.org/10.1007/s00270-009-9788-z
2. Czerny M, Reser D, Eggebrecht H, Janata K, Sodeck G, Etz C, Luehr M, Verzini F, Loschi D, Chiesa R, Melissano G, Kahlberg A, Amabile P, Harringer W, Janosi RA, Erbel R, Schmidli J, Tozzi P, Okita Y, Canaud L, Khoynezhad A, Maritati G, Cao P, Kölbel T, Trimarchi S (2015a) Aorto-bronchial and aorto-pulmonary fistulation after thoracic endovascular aortic repair: an analysis from the European Registry of Endovascular Aortic Repair Complications. Eur J Cardiothorac Surg 48(2):252–257. https://doi.org/10.1093/ejcts/ezu443
3. Ishikawa N, Hirofuji A, Wakabayashi N, Nakanishi S, Kamiya H (2020a) The cause of massive hemoptysis after thoracic endovascular aortic repair may not always be an Aortobronchial fistula: report of a case. Clin Med Insights Case Rep 13:1179547620939078. https://doi.org/10.1177/1179547620939078
4. Ishikawa N, Kikuchi S, Ishidou K, Hirofuji A, Nakanishi S, Ise H, Wakabayashi N, Kamiya H (2019a) Failed transcatheter pulmonary artery embolization in a patient suffering from massive hemoptysis after thoracic endovascular aortic repair. Clin Med Insights Case Rep 12:1179547619896577. https://doi.org/10.1177/1179547619896577
5. Julià-Serdà G, Freixinet J, Abad C, Rodriguez de Castro F, López L, Caminero J, Cabrera P (1996a) Massive hemoptysis as a manifestation of fistulized thoracic aortic aneurysms into the bronchial tree. J Cardiovasc Surg (Torino) 37(4):417–419