PMC5339407_01
Chest CT revealing multiple foci of ground glass opacity in the middle and right lower lobe.
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On admission to our hospital the patient underwent a CT angiography of the thoracic aorta and its branches (including bronchial arteries) which revealed some mild anatomical abnormalities in the bronchial arteries suppling the right lower lobe and ground glass opacities in the middle and right lower lobe, without showing a specific bleeding origin (Fig. 1).
CT pulmonary artery angiography detected thrombus within segmental branches of the left pulmonary artery (circles).
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Thus, a CT pulmonary angiography was performed which revealed a large thrombus on the left main artery involving the pulmonary arteries for the left upper, the lingual, and the left lower lobe (Fig. 2).
(a) Selective catheterization and initial digital subtracted angiography (DSA) of the right bronchial artery. (b) Super-selective distal catheterization of the right bronchial artery with a micro-catheter demonstrating blushing and extravasation of contrast at the distal arterial segment (circle). (c) Super-selective DSA following embolization. Note the opacification of the occluded vessels created by the embolic material (arrows). (d) Final DSA from the origin of the right bronchial artery, demonstrating patency of bronchial branches of the upper and lower right lobe and complete occlusion of the bronchial branches of the middle lobe with no signs of bleeding.
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Final angiogram demonstrated complete occlusion of the target vessels without any sign of bleeding (Fig. 3).
Post-procedural chest CT demonstrating consolidation of the right lower lobe at the area of embolization. Note the embolic material (glue) within the consolidation (white arrows).
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Post-procedural chest CT revealed a consolidation of the right lower lobe suggestive of a pneumonia (Fig. 4).