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Recurrent hemoptysis in pediatric bronchial Dieulafoy’s disease with inferior phrenic artery supply:A case report

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世界临床病例杂志 2023年第26期11卷 6268-6273页

作者： Fang Wang Jiao Tang Mou Peng Pu-Jue Huang Li-Juan Zhao Yin-Yue Zhang Tao Wang Department of Pediatric Cardiology West China Second University HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina Department of Pediatrics The First People's Hospital of Longquanyi DistrictChengdu 610041Sichuan ProvinceChina Department of Pediatrics Western Theater General HospitalChengdu 610041Sichuan ProvinceChina Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University) Ministry of EducationChengdu 610041Sichuan ProvinceChina Key Laboratory of Development and Diseases of Women and Children of Sichuan Province Chengdu 610041Sichuan ProvinceChina

BACKGROUND Bronchial Dieulafoy’s disease(BDD)is characterized by the erosion of an anomalous artery in the submucosa of the bronchus.The etiology of pediatric BDD is mainly congenital dysplasia of bronchus and pulmonary arteries,which is different from chronic inflammatory injury of the airway in adult patients.The internal thoracic artery,subclavian artery,and intercostal artery are known to be involved in the blood supply to the BDD lesion in children.CASE SUMMARY We report a case of BDD in a 4-year-old boy with recurrent hemoptysis for one year.Selective angiography showed a dilated right bronchial artery,and anastomosis of its branches with the right lower pulmonary vascular network.Bronchoscopy showed nodular protrusion of the bronchial mucosa with a local scar.Selective embolization of the bronchial artery was performed to stop bleeding.One month after the first intervention,the symptoms of hemoptysis recurred.A computed tomography angiogram(CTA)showed another tortuous and dilated feeding artery in the right lower lung,which was an abnormal ascending branch of the inferior phrenic artery(IPA).The results of angiography were consistent with the CTA findings.The IPA was found to be another main supplying artery,which was not considered during the first intervention.Finally,the IPA was also treated by microsphere embolization combined with coil interventional closure.During the one-year follow-up,the patient never experienced hemoptysis.CONCLUSION The supplying arteries of the bleeding lesion in children with BDD may originate from multiple different aortopulmonary collateral arteries,and the IPA should be considered to reduce missed diagnosis.CTA is a noninvasive radiological examination for the screening of suspected vessels,which shows a high coincidence with angiography,and can serve as the first choice for the diagnosis of BDD.

关键词： hemoptysis Child Bronchial Dieulafoy’s disease Inferior phrenic artery Interventional treatment Case report

Supplementary inferior phrenic artery embolization in the interventional treatment of hemoptysis

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Chinese Medical Journal 2009年第5期122卷 514-520页

作者： LIU Feng-yong WANG Mao-qiang FAN Qing-sheng DUAN Feng WANG Zhi-jun SONG Peng Department of Interventional Radiology Clinical Division of Medicine Chinese People's Liberation Army General Hospital Beijing 100853 China

Background Transcatheter bronchial artery embolization （BAE） is widely used for the treatment of hemoptysis and the immediate success rate is high, but there are still some hemorrhage recurrences. One of the common reasons for failure of BAE is collateral branches as blood supply. The inferior phrenic artery （IPA） is one of the most common collateral branches that is scarcely reported. Our purpose was to observe manifestations of IPA supplying to hemoptysis and evaluate the efficacy and safety of IPA embolization. Methods Angiography during interventional treatment of 178 hemoptysis patients in the past 7 years confirmed that IPA hemorrhage resulted in hemoptysis in 25 patients （26-67 years old） who had： lung cancer （11 patients）, bronchiectasis （11 patients）, chronic lung inflammation （2 patients）, and pulmonary tuberculosis （1 patient）. Among the 25 patients, 7 patients had twice interventional operations within one week and 6 patients still experienced intraoperative hemoptysis after conventional embolization of the bronchial artery, the internal thoracic artery, and the intercostal artery, then had the second interventional operation immediately. The total number of cases were 191. Selective embolization of the IPA was performed using polyvinyl alcohol microspheres, gelatin sponge particles, and microcoil. The safety and clinical significance of IPA embolization were evaluated. The Pearson X2 test and Fisher＇s exact probability test were used in this study. Results Selective IPA angiography showed increased diameter of the IPA, disorganization of the branches, and varying degrees of angiogenesis. In 11 cases, contrast material was seen in vessels supplying the tumor and in the tumor. In 9 cases, contrast material had leaked into the area supplied by the IPA; in 8 cases, non-specific flake-like deposits of contrast material were seen; and in 14 cases, abnormal communication or shunt was visualized. Lesions were closely related to the pleura in 25 patients. Fifteen lesions were close to the diaphragmatic pleura

关键词： hemoptysis inferior phrenic arteries angiography embolization, therapeutic

Bronchial Artery Embolization for hemoptysis： A Retrospective Observational Study of 344 Patients

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Chinese Medical Journal 2015年第1期128卷 58-62页

作者： Hongxia Shao Junping Wu Qi Wu Xin Sun Li Li Zhiheng Xing Hongfen Sun Graduate College of Tianjin Medical University Tianjin 300070 China Division of Pulmonary Medicine Tianjin Haihe Hospital Tianjin 300350 China Tianjin Institute of Respiratory Disease Tianjin 300350 China Radiology Department of Tianjin Haihe Hospital Tianjin 300350 China

Background：hemoptysis is a significant clinical entity with high morbidity and potential mortality.Both medical management （in terms of resuscitation and bronchoscopic interventions） and surgery have severe limitations in these patients population.Bronchial artery embolization （BAE） represents the first-line treatment for hemoptysis.This article discusses clinical analysis,embolization approach,outcomes and complications of BAE for the treatment of hemoptysis.Methods：A retrospective analysis of 344 cases,who underwent bronchial arteriography at Tianjin Haihe Hospital between 2006 and 2013.Several aspects of outcome were analyzed：Demographics,clinical presentation,radiographic studies,results,complications and follow-up of BAE.Results：Three hundred and forty-four consecutive patients underwent bronchial arteriography,336 of 344 patients （97.7%） performed BAE; there were 1530 coils for 920 arteries embolized; the main responsible sources for bleeding were right bronchial artery （29.7%）,left bronchial artery （21.6%）,combined right and left bronchial trunk （18.4%）,right intercostal arteries （13.3%）; 61 patients （17.7%） had recurrent hemoptysis within 1 month after undergoing BAE,74 patients （21.5%） had recurrent hemoptysis over 1 month after undergoing BAE; The common complications of BAE included subintimal dissection,arterial perforation by a guide wire,fever,chest pain,dyspnea,etc.The follow-up was completed in 248 patients,28 patients had been dead,21 patients still bleed,92 patients had lost to follow-up.Conclusions：The technique of BAE is a relatively safe and effective method for controlling hemoptysis.The complications of BAE are rare.Although the long-term outcome in some patients is not good,BAE may be the only life-saving treatment option in patients who are poor surgical candidates.

关键词： Bronchial Artery Embolization Complications of Bronchial Artery Embolization hemoptysis Recurrent hemoptysis

Massive hemoptysis and hemothorax： a rare but fatal complication of intralobar sequestration

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Chinese Medical Journal 2012年第14期125卷 2638-2640页

作者： WANG Hong-wei LU Jiang-yang SUN Jun-zhong, XIAO Yan WEN Bo Department of Patlaology First Affiliated Hospital of General Hospital of People's Liberation Army Beijing 100048 China Department of OncologyFirst Affiliated Hospital of General Hospital of People's Liberation Army Beijing 100048 China Respiratory Center First Affiliated Hospital of General Hospitalof People's Liberation Army Beijing 100048 China Department ofRadiology First Affiliated Hospital of General Hospitalof People's Liberation Army Beijing 100048 China

Intralobar sequestration （ILS） is an uncommon abnormality that accounts for 75% of all pulmonary sequestrations. Over the years there have been several reports of various presenting signs of which hemoptysis was commonly described, however, massive hemoptysis and hemothorax is extremely rare in literature. We present a case of a 45-year-old man who died of fatal complication from an ILS. This case report shows an uncommon presentation of ILS with massive hemoptysis and hemothorax resulting in a dramatic course of disease and a fatal outcome, and for this reason in the absence of trauma or other causes for massive hemoptysis, hemothorax, or lung hematoma, this possibility should be kept in mind so as to avoid misdiagnosis, and resection of the sequestered tissue should be considered in all patients.

关键词： hemoptysis hemothorax bronchopulmonary sequestration, autopsy

hemoptysis secondary to pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation: A case report and literature review

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Journal of Interventional Medicine 2020年第2期3卷 98-100页

作者： Zhiming Xuan Boyu Liu Minjun Ci Zhe Wang Yong Fan Tianjin Medical University TianjinGuangdong Road 1#Hexi District300202TianjinChina Department of Radiology Tianjin Medical University General HospitalAnshan Road 154#Heping District300052TianjinChina

Objectives: Pulmonary vein stenosis(PVS) is a known complication after radiofrequency ablation of atrial fibrillation(RAAF) and is often misdiagnosed owing to lack of awareness regarding PVS among noncardiologists.Misdiagnosis results in unnecessary treatment;therefore, greater understanding of PVS can improve the management of these patients.Methods: We report the case of a 38-year-old man with a history of RAAF who presented with massive hemoptysis.His symptoms persisted despite undergoing transcatheter bronchial artery embolization on two occasions.Results: Pulmonary computed tomography angiography revealed a completely occluded left superior pulmonary vein. Considering the patient’s history of RAAF, we diagnosed him with RAAF-induced PVS and performed left superior lobectomy after which hemoptysis did not recur.Conclusions: Unexplained massive hemoptysis should alert clinicians regarding the possibility of RAAF-induced PVS. Balloon angioplasty and stent placement are used to treat PVS;however, their efficacy is controversial considering the high recurrence rates associated with these interventions.

关键词： hemoptysis Pulmonary vein Radiofrequency ablation Atrial fibrillation

Treatment for hemoptysis after percutaneous closure of a large intralobar pulmonary sequestration in elderly patient

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Journal of Geriatric Cardiology 2020年第9期17卷 585-588页

作者： Jian-Ming WANG Qi-Guang WANG Duan-Zhen ZHANG Xian-Yang ZHU Department of Congenital Heart Disease General Hospital of Northern Theater CommandShenyangChina

Pulmonary sequestration is a rare congenital cardiovascular malformation.[1,2]Open surgical excision is the usual treatment,although thorascopic intervention and transcatheter embolization have been reported.However,only a limited number of articles involving percutaneous closure the rare pulmonary malformations have been published in the literature.[3]What’s more,previous studies involving percutaneous pulmonary sequestration closure with repeated respiratory symptoms at the very young age suggested that the optimal therapeutic strategy has yet to be determined.[4]We hereby describe a particular case of percutaneous closure of a large intralobar pulmonary sequestration at elderly age.

关键词： Cardiac catheterization hemoptysis Interventional embolization Pulmonary sequestration

Pheochromocytoma with abdominal aortic aneurysm presenting as recurrent dyspnea,hemoptysis,and hypotension:A case report

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World Journal of Clinical Cases 2021年第18期9卷 4754-4759页

作者： Hai-Yang Zhao Yong-Zhen Zhao Yu-Mei Jia Xue Mei Shu-Bin Guo Emergency Medicine Clinical Research Center Beijing Chaoyang HospitalCapital Medical University&Beijing Key Laboratory of Cardiopulmonary Cerebral ResuscitationBeijing 100020China Department of Endocrinology Beijing Chaoyang HospitalCapital Medical UniversityBeijing 100020China

BACKGROUND Pheochromocytomas are rare endocrine tumors with various clinical manifestations,and few of them might present with profound,life-threatening conditions.CASE SUMMARY We report the case of a 65-year-old man who complained of sudden dyspnea and hemoptysis for half a day.There was no obvious cause for the patient to have dyspnea,coughing,or coughing up to approximately 100 mL of fresh blood.Finally,he was diagnosed with pheochromocytoma crisis(PCC),coexisting with an abdominal aortic aneurysm(AAA).CONCLUSION We report a case of pheochromocytoma presenting with recurrent hemoptysis,dyspnea and hypotension coexisting with an AAA.It not only proved the uncommon manifestations of pheochromocytoma but also directed clinicians to consider PCC among the possible diagnoses when meeting similar cases.Moreover,surgical excision is the most beneficial method for the treatment of pheochromocytoma coexisting with AAA when the situation is stable.

关键词： Emergency hemoptysis Hypotension Pheochromocytoma crisis Abdominal aortic aneurysm Case report

Uncommon pulmonary infection with recurrent hemoptysis

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Chinese Medical Journal 2007年第24期120卷 2331-2333页

作者： Ljudmila Nagorni-Obradovic Dragica Pesut Ruza Stevic Jelena Stojsic School of Medicine University of Belgrade Institute of Lung Diseases and Tuberculosis Clinical Centre of Serbia BelgradeSerbia

Pulmonary actinomycosis is a rare, uncommon pulmonary infection. The word ＂actinomycosis＂ is derived from Greek terms aktino, which refers to the radiating appearance of a sulphur granule and mykos, which labels the... 详细信息

关键词： pulmonary actinomycosis hemoptysis surgery

A Rare Cause of Recurrent Fatal hemoptysis:Dieulafoy's Disease of the Bronchus

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Chinese Medical Journal 2018年第22期131卷 2758-2759页

作者： Feng Wang Tu-Guang Kuang Jian-Feng Wang Yuan-Hua Yang Department of Respiratory and Critical Care Medicine Beijing Chaoyang HospitalBeijing Institute of Respiratory Medicine and Capital Medical UniversityBeijing 100020China Department of Intervention Therapy Beijing Chaoyang HospitalBeijing Institute of Respiratory Medicine and Capital Medical UniversityBeijing 100020China

To the Editor:Dieulafoy's disease is characterized by the tortuous arteries of abnormally large caliber running within the submucosa, which is susceptible to ulceration and bleeding.This vascular abnormality usually occurs in the gastrointestinal tract.The involvement in the respiratory system is rare.Massive hemoptysis caused by Dieulafoy's disease of the bronchus is a life-threatening condition.An immediate and effective treatment is required in emergency to improve survival.Here,we report a patient who had such a vascular anomaly in bronchus and presented with recurrent massive hemoptysis.The patient signed information consent form.

关键词： Rare Cause Recurrent Fatal hemoptysis