BACKGROUND Hemoptysis due to airway hemorrhage is treated with hemostatic agents, bronchial artery embolization (BAE), or surgical resection. We present the case of a 65-year-old man with refractory hemoptysis associated with chronic progressive pulmonary aspergillosis (CPPA) who failed to respond to combined endobronchial occlusion (EBO) with endobronchial Watanabe spigot (EWS) and BAE. CASE REPORT A 63-year-old man was diagnosed with CPPA in the right upper lung and presented to our hospital 2 years later for hemoptysis at age 65. He developed severe hemoptysis during an outpatient visit, and was urgently admitted, intubated, and ventilated to prevent choking on blood clots. Chest computed tomography showed a large mass in the apical portion of the right lung, constituting apical pleural thickening and an encapsulated pleural effusion, and dilatation in the bronchial artery supplying the right upper lung lobe. Bronchoscopy revealed the right upper lobe B1-B3 as the bleeding source. The patient had recurrent hemoptysis that was not controlled by BAE or 6 EBO+EWS procedures, and he ultimately died of hypoxemia.In the literature review, EBO+EWS can effectively control hemoptysis in appropriate cases, without the need for BAE or surgical lung resection. It is less invasive, is associated with fewer adverse events than BAE or surgery, and can achieve temporary hemostasis for severe hemoptysis. CONCLUSIONS BAE and EBO+EWS were ineffective in controlling recurrent hemoptysis caused by CPPA in this case. However, a multidisciplinary approach such as attempting hemostasis with combined EBO+EWS and BAE may be a viable treatment option in severe cases of hemoptysis.

BACKGROUND: The development of bronchial hemangioma in adults is rare, and massive hemoptysis due to diffuse vascular proliferation of bronchial hemangioma is fatal.
METHODS: A case of a 29-year-old woman kept massive hemoptysis even after being underwent repeated interventional embolization for recurrent massive hemoptysis. Eventually, the patient was performed the operation of right upper lung lobectomy and bronchial hemangioma with extracorporeal membrane oxygenation support and was followed up for 4 years without recurrent hemoptysis.
METHODS: Bronchial hemangioma.
CONCLUSIONS: For patients with bronchial angiomas bonded with bronchial artery-pulmonary arteriovenous fistulae, the early surgical resection is recommended if bronchial artery embolization (BAE) is considered ineffective.

Bronchial artery aneurysm (BAA) is a rare disease, and multiple aneurysms of a single bronchial artery are rarer. Regardless of the size of the lesion, it is at risk of rupture and can cause massive hemoptysis or severe pain. We report a rare case of bronchial artery embolization (BAE) of multiple aneurysms of a single bronchial artery. During medical examination, a 64-year-old female was diagnosed with multiple BAAs and endobronchial lesions in the right lower lung on CT 10 years prior to presentation to our hospital. Further evaluation of the lesions was recommended; however, the patient was lost to follow-up. The patient complained of dyspnea and visited our hospital, and the size of the BAA had increased on CT. BAE was done successfully using N-butyl-2-cyanoacrylate and detachable coils. Follow up CT after BAE showed significant decrease in extent of inflammatory lesion in the right lung.
기관지 동맥류는 전 세계적으로 드문 질환으로 특히 한 개의 기관지 동맥에서 기인한 여러 개의 동맥류는 매우 드물다. 이는 병변의 크기에 상관없이 파열의 위험이 있고 대량 객혈과 심각한 통증을 유발할 수 있다. 저자들은 하나의 기관지 동맥에서 발생한 다발성 동맥류에 대해 성공적으로 색전한 증례를 보고하고자 한다. 64세 여성이 10년 전 건강검진에서 시행한 흉부 CT에서 다수의 기관지 동맥류와 우하폐의 기관지 병변이 발견되었다. 환자는 이에 대한 추가적 검사를 권유받았으나 거절 후 추적 소실되었다. 이후 호흡곤란을 주소로 내원 후 시행한 흉부 CT에서 기관지 동맥류의 크기가 증가한 소견을 보였고, 동맥류에 대해 분리코일, N-butyl-2-cyanoacrylate를 이용하여 성공적인 색전술을 시행하였다. 색전술이후 추적 흉부 CT에서 우하폐의 염증성 병변의 범위가 감소한 것이 확인하였다.

We present a patient with life-threatening airway bleeding from an infectious pulmonary cavity with limited treatment options. Bronchial artery embolization was unsuccessful. Surgery was not feasible due to compromised lung function. Lung transplant was considered but not endorsed. Palliative hemostatic radiotherapy with 20 Gy in 5 fractions was delivered to the site of bleeding as a last resort. Hemoptysis gradually disappeared within a month and did not recur during the 4‑month follow-up. There were no side effects. We highlight the potential of radiotherapy for massive hemoptysis of infectious etiology, especially in cases with exhausted standard treatment options.

The coronary artery as a responsible vessel for hemoptysis is very rare. This patient was admitted to the hospital with bronchiectasis and hemoptysis, and the right coronary artery was found to be one of the non-bronchial systemic arteries by computed tomography angiography, and the hemoptysis stopped immediately after successful embolization of all bronchial arteries and non-bronchial systemic arteries by bronchial artery embolization. However, the patient had a recurrence of a small amount of hemoptysis 1 month and 3 months after surgery. The patient underwent lobectomy of the lesion after multidisciplinary discussion and did not have any hemoptysis after surgery.
冠状动脉作为咯血的责任血管是非常罕见的。本例患者以支气管扩张伴咯血收入院，CT血管成像发现冠状动脉作为非支气管体循环动脉的一支，支气管动脉栓塞术成功栓塞所有异常支气管动脉及非支气管体循环动脉后咯血立即停止。但是，患者术后1及3个月均再发少量咯血，经多学科讨论后行病变肺叶切除术，术后未再咯血。.

OBJECTIVE: Bronchial Dieulafoy\'s disease (BDD) is a rare disease that causes massive hemoptysis. This paper reports a case of BDD treated surgically. At the same time, we summarize the data of BDD patients reported in domestic and foreign literature to improve the understanding, diagnosis and treatment of this disease.
METHODS: A case of BDD with hemoptysis during bronchoscopy was reported. In addition, we searched for \"bronchial Dieulafoy disease\" through Pubmed, Web of Science, CNKI and Wanfang databases, covering the literature related to BDD that was definitely diagnosed or highly suspected from January 1995 to December 2021, and summarized the clinical characteristics, chest imaging, bronchoscopic manifestations, angiographic characteristics, pathological characteristics, treatment and outcome of patients.
RESULTS: The patient was a 68 year old male. Tracheoscopy revealed nodular and mass like changes in the basal segment of the left lower lobe, which appeared massive hemorrhage when touching the surface. The computed tomography angiophy of the bronchial artery confirmed that the branches of the left bronchial artery were tortuous and dilated, and then the left lower lobe of the lung was resected. During the operation, 3 thick tortuous nutrient artery vessels were sent out from the descending aorta, and 1 thick tortuous nutrient artery was sent out from the autonomic arch. All of them were ligated and cut. The pathology after the operation was in accordance with BDD; The patient did not have hemoptysis after discharge and is still under follow-up. The database identified 65 articles from January 1995 to December 2021. After removing repeated reports, meetings, incomplete information and nursing literature, 60 articles were included to report 88 cases of BDD. BDD can occur at all ages, with a male to female ratio of about 1.6:1. It mainly starts with hemoptysis, and can also be seen due to cough, infection, and respiratory failure; Inflammatory changes such as pulmonary patch shadow, exudation shadow and ground glass shadow of pulmonary hemorrhage were more common in chest imaging; The diagnosis of BDD is mainly based on the bronchoscopy, bronchial angiography and pathological findings of surgical or autopsy specimens. Bronchoscopic findings were mostly non pulsating, smooth nodular or mucosal processes. Bronchial angiography mainly showed tortuous dilatation of bronchial artery, and the lesions were mainly located in the right bronchus, more from the bronchial artery; Diagnosis depends on pathology, showing submucosal expansion of bronchus or abnormal artery rupture and bleeding; 54 cases underwent selective bronchial artery embolization, 39 cases underwent pulmonary lobectomy, 66 cases improved, and 10 cases died (all of them were caused by massive hemorrhage during bronchoscopic biopsy).
CONCLUSIONS: BDD is rare, but may cause fatal massive hemoptysis. Bronchial angiography is considered to be an effective method to diagnose BDD. Since pathological biopsy may lead to fatal bleeding, the necessity of pathological diagnosis remains controversial. Interventional and surgical treatment plays an important role in patients with cough accompanied by massive hemoptysis.

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OBJECTIVE: To describe the technique and document utility of adjunctive cone-beam CT (CBCT) in patients undergoing bronchial artery embolization (BAE) or chemoinfusion (BAC).
METHODS: Between August 2010 and February 2021, 26 patients (62 bronchial arteries) were evaluated with CBCT in addition to the usual digital subtraction angiography (DSA) during BAE or BAC. 19 patients (43 arteries) underwent BAE for hemoptysis; 7 patients (19 arteries) had BAC for palliation of lung malignancy. Retrospective review of procedural reports and the archived DSA and CBCT images was assessed for (1) whether CBCT findings added unique diagnostic information prior to treatment of target arteries compared to DSA alone; and (2) whether these unique CBCT findings led to modification of embolization or chemoinfusion technique.
RESULTS: In 61 of 62 (98%) interrogated bronchial arteries, CBCT provided additional unique diagnostic information over planar DSA, primarily cross-sectional assessment of the spinal canal for spinal arteries. In 46/62 (74%) of the bronchial arteries the unique information did not lead to a change in therapeutic technique. In 15 bronchial arteries (24%), the added information from CBCT led to change in embolization and/or chemoinfusion technique. Embolization of one small unrecognized spinal artery branch (1.6%), which was missed intra-procedurally but retrospectively seen on CBCT led to transient spinal cord ischemia.
CONCLUSIONS: These results suggest that adjunctive use of CBCT technique may improve diagnostic confidence from information provided by DSA in nearly all cases of BAE and BAC leading to improved therapeutic targeting or change in technique of embolization or chemoinfusion.

Hemoptysis is a frequently encountered symptom of the respiratory system in adult but is rare in children. Bronchial artery-pulmonary artery fistula (BPF) is one of the most important and life-threatening cause in pediatric hemoptysis patients. Although the severity of BPF has been proved in previous studies, details about clinical diagnosis and treatment of BPF in children have been rarely reported.
A 12-year-old boy presented to the hospital with hematemesis after coughing, without any other symptoms. After admission, he had repeated hemoptysis, 20-30 ml each time, and on the 11th night of admission a massive hemoptysis (about 100 ml bright red blood) occurred suddenly. Chest computed tomography demonstrated patchy ground glass opacities in the right lung, suggestive of pulmonary hemorrhage. Bronchial arteriography showed an apparent BPF in the right lobe bronchial artery. Therefore, bronchial artery embolization was performed, following which a thrombus in the bronchial lumen was removed by bronchoscopy. After these interventions, the patient recovered quickly and no recurrence was noted in the following year.
We believe that this case should raise awareness of cryptogenic massive hemoptysis caused by BPF. In the event of hemoptysis in a child, it is important to clarify the source of the bleeding. If common etiologies have been excluded, the presence of pulmonary and bronchial vascular malformations should be considered. Moreover, multidisciplinary collaboration is crucial in the diagnosis and management of cryptogenic hemoptysis.