PMC9630766_01
Contrast-enhanced CT showed GGA in the right middle lobe (arrows) and endobronchial shadow in the right upper bronchial entrance (dotted area). (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)
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Contrast-enhanced computed tomography (CT) also showed GGA in the right middle lobe and an endotracheal shadow in the right upper bronchial entrance (Fig. 1).
Bronchofiberscopy (BFS) revealed an elevated lesion that resembled a malignant tumor (A). BFS after a biopsy shows that the lesion shrank (B). Three months after hospitalization, the patient required intensive care, and BFS revealed that the lesion had increased in size (C). BFS after BAE showed that the lesion had shrunk; however, a residual lesion was still present (D-E). Endobronchial lesions could not be observed because of the large amount of blood clots (F).. BAE, bronchial arterial embolization, BFS, bronchofiberscopy. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)
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Bronchoscopy results revealed an elevated lesion at the entrance of B3 (Fig. 2A). Bronchoscopy performed after intubation showed that the lesion had shrunk (Fig. 2B). Three months after discharge, bronchoscopy revealed that the lesion had increased in size (Fig. 2C). BAE, her symptoms immediately improved. Bronchoscopy after BAE showed that the lesion had shrunk; however, a residual lesion was still present (Fig. 2D and E). BAE revealed no active bleeding, the endobronchial lesion could not be observed because of massive blood clots (Fig. 2F). Because the patient wanted a curative treatment, a thoracoscopic right upper lobectomy was performed to prevent recurrence of hemoptysis.
Angiography of the right bronchial arteries showed enlarged and convoluted bronchial arteries with pulmonary artery shunts (A). After the first BAE, abnormal vessels disappeared (B). Five months after the first BAE, angiography of right bronchial arteries revealed that the right bronchial arteries had developed and had shunts between the bronchial and pulmonary arteries again. In addition, the contrast medium leaked out of the lesion in the bronchus and was discharged by coughing (arrow) (C-E). (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)
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Angiography of the right bronchial arteries indicated enlarged and convoluted bronchial arteries with pulmonary artery shunts (Fig. 3A). Based on angiography findings and the absence of pulmonary diseases, she was diagnosed with primary RHBA, and BAE using a gelatin sponge was performed (Fig. 3B). In addition, the contrast medium leaked out of the lesion in the bronchus, and it was discharged by coughing (Fig. 3C, D, 3E; Movie 2).
On gross appearance, endobronchial lesions were not observed in the surgical specimens (A-B). The peribronchial arteries were embolized with embolic material (dotted area) (C). Accumulation of red blood cells was observed in the alveoli (arrows) (D). Minute meningothelial-like nodules were found in the peripheral lung (arrowheads) (E-F). (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)
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On gross appearance, endobronchial lesions were not observed in the surgical specimens (Fig. 4A and B). Although the peribronchial arteries were embolized with embolic material (Fig. 4C), red blood cells accumulated in the alveoli (Fig. 4D). In addition, minute meningothelial-like nodules were incidentally found in the peripheral lung (Fig. 4E and F).