PMC5667299_01
A, Computed tomography findings in a 63-year-old woman at admission revealed an infiltrative shadow in the right lung field. B, Bronchial angiography showed dilatation >2 mm on the proximal side of the right main bronchial artery and diffuse angiectasis >0.5 mm on the distal side. C, Bronchoscopic findings showed massive blood clots in the right main bronchus. D, The day after admission, the patient suffered massive hemoptysis triggered by coughing and severely poor ventilation caused by asphyxia. One-lung ventilation was obtained by temporarily inserting an endotracheal tube into the left main bronchus to secure ventilation. E, Following emergency bronchial angiography, the culprit vessel was detected by use of a microcatheter. Bronchial artery embolization was carried out.
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Intercostal angiography carried out at that time also revealed extravascular leakage from the lobar bronchus to right main bronchus (Fig. 2D, Video S1).
PMC5667299_02
A, Computed tomography findings in a 63-year-old woman at admission revealed an infiltrative shadow in the right lung field. B, Bronchial angiography showed dilatation >2 mm on the proximal side of the right main bronchial artery and diffuse angiectasis >0.5 mm on the distal side. C, Bronchoscopic findings showed massive blood clots in the right main bronchus. D, The day after admission, the patient suffered massive hemoptysis triggered by coughing and severely poor ventilation caused by asphyxia. One-lung ventilation was obtained by temporarily inserting an endotracheal tube into the left main bronchus to secure ventilation. E, Following emergency bronchial angiography, the culprit vessel was detected by use of a microcatheter. Bronchial artery embolization was carried out.
AMS2-4-114-g001.jpg
PMC5667299_02_AMS2-4-114-g001.jpg
ams2227-fig-0001
Intercostal angiography carried out at that time also revealed extravascular leakage from the lobar bronchus to right main bronchus (Fig. 2D, Video S1).
A, Contrast-enhanced computed tomography findings of a 72-year-old man revealed only ground-glass opacity that was dominant in the right lung field. No vascular abnormality nor extravascular leakage was noted. B, Vascular dilatation >2 mm was found on the central side; the vascular abnormality in the periphery showed diffuse spreading. C, D, While securing the safety of the airway, blood clots were aspirated with a bronchoscope during angiography, which resulted in confirmation of massive foamy hemoptysis. Intercostal angiography at that time also revealed extravascular leakage from the lobar bronchus to right main bronchus. E, Angiographic findings after airway suctioning showed visible changes in the vascular abnormality in the periphery of the right bronchial artery. Thus, the culprit vessel causing massive hemoptysis was identified by removing blood clots. F, Embolization of the right bronchial artery was carried out.
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Respiratory status was stable on admission and he underwent chest contrast-enhanced computed tomography without intubation, which revealed only ground-glass opacity dominant in the right lung field (Fig. 2A). As in Case 1, vascular dilatation >2 mm was found on the proximal side, while the vascular abnormality in the periphery showed diffuse spreading (Fig. 2B). While securing airway safety, blood clots were aspirated with bronchoscopy during angiography, resulting in confirmation of massive foamy hemoptysis (Fig. 2C). Intercostal angiography carried out at that time also revealed extravascular leakage from the lobar bronchus to right main bronchus (Fig. 2D, Video S1). E) in the periphery after removing blood clots, and the culprit vessel causing massive hemoptysis was identified. Embolization of the right bronchial artery was carried out using Gelfoam (Fig. 2F).