Proximal pulmonary artery embolization for recurrent hemoptysis after bronchial artery embolization

Abstract

Proximal pulmonary artery (PA) embolization is a dramatic interventional radiology procedure performed to control recurrent, life-threatening hemoptysis. Distal PA embolization procedures are commonly performed, and preoperative proximal PA embolization procedures have been reported, but to the best of our knowledge there has not been a reported case of a proximal PA embolization to treat hemoptysis. Here, we present a case of a complete proximal PA embolization that effectively resolved recurrent hemoptysis in a patient with a lung tumor following a failed bronchial artery embolization.

Keywords: Embolization; hemoptysis; proximal pulmonary artery.

Figure 1.

Pulmonary artery (PA) digital subtraction angiograms (a) before embolization, showing normal left PA branching anatomy with marked narrowing of the left upper lobe PA just distal to the apical branches secondary to compression from of the large mass, and (b) after embolization, demonstrating embolization of the proximal left PA using a combination of vascular plugs and embolization coils. This image shows some PA opacification distal to the vascular plug; however, the left PA distal to the plug is significantly decreased in size distal to the embolic plug (4 mm) compared to the same location prior to embolization (15 mm) with near complete stasis expected to occur over time.

Figure 2.

CT of the chest 3 months after the pulmonary artery (PA) embolization procedure. (a) Axial image revealing the hyperdense vascular coil plug in the proximal left PA. Also shown are a significant beam hardening artifact from the vascular plug and significantly decreased opacification of the PA system distal to the plug, consistent with near complete embolization. (b) Coronal image with contrast showing the hyperdense coil embolus with significantly decreased opacification of the PA downstream from the plug.