Journal Information
Vol. 26. Issue 1.
Pages 53-54 (January - February 2020)
Share
Share
Download PDF
More article options
Vol. 26. Issue 1.
Pages 53-54 (January - February 2020)
Letter to the Editor
DOI: 10.1016/j.pulmoe.2019.07.002
Open Access
Long-life relationships always bring trouble
Visits
...
A.M. Mutiozabala,
Corresponding author
, M.D. Santiañezb, J.I. De Granda Orivea
a Respiratory Medicine, Hospital Universitario 12 de Octubre, Avda. De Cordoba s/n, 28041 Madrid, Spain
b Internal Medicine, Hospital Universitario 12 de Octubre, Avda. De Cordoba s/n, 28041 Madrid, Spain
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Full Text

A 58-year-old woman, a butcher from her youth and a history of hemoptysis related to respiratory infection at the age of 30, was admitted into Intensive Care Unit for life-threatening hemoptysis and respiratory hypoxemic insufficiency. The bronchoscopy identified bleeding coming from the lower right lobe with an incipient clot. Computerized thoracic tomography revealed ground glass opacities in the middle and lower right lobes, probably indicative of blood filling alveoli. She was extubated 24h later and continued on antittussive treatment and amoxicillin/clavulanic acid until hemoptysis diminished in the following days. It was assumed that the risk of life-threatening rebleeding was high, so bronchial arterial embolization was performed. The arteriography detected the presence of a fistula connecting right bronchial (Fig. 1A) and pulmonary arteries and it was occluded with bead-block particles of 500–600μm. The subsequent control demonstrated flow extinction, the fistula was completely blocked (Fig. 1B). A week later, in the absence of hemoptysis, the patient was discharged.

Figure 1.

Description. Angiography preprocedure (A) shows hypertrophy of right bronchial artery and the presence of a fistula between bronchial artery and pulmonary artery. Angiography postprocedure (B) shows the absence of flood to pulmonary artery.

(0.11MB).

Arterial malformations are commonly found in angiography conducted in hemoptysis.1 Cases of systemic-pulmonary circulation shunts have been reported within parenchymal lung involvement, mostly due to bronchiectasis2 or tuberculosis sequelaes,3 and rarely due to hereditary haemorragic telangiectasia.4 We present an elderly woman with a congenital brochial-pulmonary artery fistula and life-threatening hemoptysis, who was embolized with inmediate successful angiographic result. Embolization is seen as a safe and effective treatment for life-threatening hemoptysis, recurrence rates depend on different ethiologies.1 Our patient has a considerable risk of rebleeding, that may lead to repeat embolization or elective surgery in the future.

Conflicts of interest

The authors have no conflicts of interest to declare.

Funding

There is no funding for this manuscript.

References
[1]
H. Liu, D. Zhang, F. Zhang, J. Ying.
Immediate and long-term outcomes of endovascular treatment for massive hemoptysis.
Int Angiol, 35 (2016), pp. 469-476
[2]
E. Yakushiji, S. Ota, T. Komatsu, M. Ayaori, K. Ikewaki.
Massive hemoptysis due to right inferior phrenic artery-to-right pulmonary artery fistula in the right middle lobe of the lung.
Intern Med, 56 (2017), pp. 687-689
[3]
L. Gorospe Sarasúa, F.E. Farfán-Leal, R. García-Latorre.
Embolization of acquired bronchial artery-pulmonary artery fistula in a patient with HIV infection.
Arch Bronconeumol, 52 (2016),
[4]
H.H. Wong, R.P. Chan, R. Klatt, M.E. Faughnan.
Idiopathic pulmonary arteriovenous malformations: clinical and imaging characteristics.
Eur Respir J, 38 (2011), pp. 368-375
Pulmonology

Subscribe to our newsletter

Article options
Tools

Are you a health professional able to prescribe or dispense drugs?

Cookies policy
To improve our services and products, we use cookies (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.