Successful embolization of bronchial artery aneurysms

Dr Elena Lonjedo Vicent, MD. Prof.Interventional and Vascular UnitUniversitary Hospital Dr Peset Valencia

Disclosure

Speaker name:

DR Elena Lonjedo

I have the following potential conflicts of interest to report:

Consulting

Employment in industry

Stockholder of a healthcare company

Owner of a healthcare company

Other(s)

I do not have any potential conflict of interest

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Mediastinal bronchial artery aneurysms (BAA) are uncommon, with fewer than 50 published case reports.They are identified in <1% of bronchial selective arteriograms.They are anatomically classified into mediastinal or extrapulmonary and intrapulmonary

Mediastinal Bronquial Artery Aneurysm: anuncommon patology.

Transarterial Embolization Treatment

Clinical presentation

Clinical presentation varies from an incidental finding to hemoptysis or hemomediastinum and shock resulting from rupture.

Extrapulmonary bronchial aneurysm manifests as a spontaneous mediastinal hematoma that presents with severe retrosternal pain resembling an acute coronary syndrome or aortic dissection.

Intrapulmonary aneurysms manifests as intermittent or massive hemoptysis

Ethiology

Many predisposing conditions have beendescribed in the setting of BAA includingbronchiectasis, atherosclerosis trauma, radiationtherapy, mycotic infection and Osler-Weber-Rendu syndrome.This suggests that the etiology of theseaneurysms may be related to the chronicinflammatory state or to the hyperafflux of thevessels involved

DiagnosisAngioTc is the diagnostic method of choice,

relegating arteriography for diagnostic confirmationand treatment.

Xray filmCt

MRIArteriography

TREATMENT

Treatment may be surgical, with graftstent or transarterial embolization

CASE 154-year-old manClinical history of an infected bronchiectasis

AngioTC:aneurysm at the origin of the left bronchial artery (20x14 mm)

CASE 1

Transarterial embolization with steel coils

3 months Follow up: complete occlusion of aneurysm

CASE 1

81 years-old-man

●Medical history of chronic bronchitis

●Bilateral upper lobe bronchiectasis with episodes of hemoptysis

●Currently presented to our emergency department with fever, pleuritic chest

pain, productive cough, and an elevated WBC

CASE 2

CASE 2

AngioTC: mediastinal window showed a 12 mm aneurysm proximal to the origin of an hypertrophic left bronchial artery, with a significant stenosis proximal to the aneurysm

AngioTC: lung window showed a change of chronic bronchitis and bilateral cystic bronchiectasis

CASE 2

Transarterial embolization with Onyx

Discussion

Rare disease

There is currently an increse in incidence as a casual finding in CT images

It is important to treat the injury before it breaks, specially in mediastinal

aneurysm.

Endovascular embolization seems to be the best therapeutical option

Depending on the neck, the caliber of the vessel , the stability of the

catheter we used different embolizing agents

Conclusion:

We present two cases of bronchial

aneurysms treated with embolization

with good clinical and morphological

outcome with detachable coils and

with onyx without complications.

References:

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Successful embolization of bronchial artery aneurysms

Dr Elena Lonjedo Vicent, MD. Prof.Interventional and Vascular UnitUniversitary Hospital Dr Peset Valencia