Endovascular treatment of isolated systemic arterial supply to normal lung with coil and glue embolisation

Abstract

Surgery is the standard treatment for the extremely rare pathology of isolated anomalous systemic arterial supply to normal lung (ISSNL). We describe our experience with this anomaly in a 29-year-old male presenting with recurrent haemoptysis that was successfully treated with a combination of metallic coils and cyanoacrylate glue. In addition to contributing to the extremely limited data on endovascular therapeutic options in ISSNL, we also intend to raise the awareness among endovascular therapists of the need to be cautious ofand preserve the radiculomedullary/pial branches arising from an anomalous artery before embolising it.

Figure 1

In these contrast enhanced CT images the anomalous artery (white arrow) arising from the thoracic aorta and supplying the left basal segments is demonstrated in three orthogonal planes (a–c). (d) Note the ill-defined, faint airspace haziness and increased vascularity in the affected basal segment of the left lower lobe.

Figure 2

(a) The thoracic aortogram shows the origin and tortuous course of the anomalous artery. (b) Selective injection into the anomalous artery demonstrates the branching pattern and parenchymal blush of the subtending segments of lung. (c) Selective injection into the trunk of the anomalous artery post-embolisation with coils and NBCA glue shows no parenchymal enhancement but the spinal artery is preserved. (d) Follow up radiograph at 3 months does not show any evidence of pulmonary infarction.