Myriad Faces of Active Tuberculosis: Intrapulmonary Bronchial Artery Pseudoaneurysm

Bronchial artery (BA) pseudoaneurysm is an uncommon vascular complication of tuberculosis (TB), and early diagnosis is crucial due to risk of rupture and life-threatening hemorrhage. Immediate intervention is warranted in massive hemoptysis due to high mortality. Various causes of massive hemoptysis are TB, bronchiectasis, aspergilloma, lung abscess, lung cancer, necrotizing pneumonia, and cystic fibrosis. Active pulmonary TB as well as chronic pulmonary TB can manifest with massive hemoptysis. Hemoptysis in active TB occurs due to ulceration in bronchiolar wall, eroding the wall of the adjacent BA or pulmonary artery, and in chronic TB due to hypertrophied bronchial arteries, or bronchiectasis, or aspergilloma. Herein, we report a case of pulmonary TB causing intrapulmonary BA pseudoaneurysm in a young male patient who presented with acute massive hemoptysis. The BA pseudoaneurysm as well as other hypertrophied bronchial arteries were embolized using polyvinyl alcohol (PVA) particles.

1. Bruzzi, JF, Rémy-Jardin, M, Delhaye, D, Teisseire, A, Khalil, C, Rémy, J. Multi–detector row CT of hemoptysis. RadioGraphics. 2006;26(1):3-22. doi:
10.1148/rg.261045726.
Google Scholar | Crossref | Medline2. Seo, JB, Song, K-S, Lee, JS, et al. Broncholithiasis: review of the causes with radiologic-pathologic correlation. RadioGraphics. 2002;22(suppl_1):S199-S213. doi:10.1148/radiographics.22.suppl_1.g02oc07s199.
Google Scholar | Crossref | Medline3. Fujita, J, Akashi, K, Kunikane, H, et al. A case of bronchial artery aneurysm demonstrating a mass shadow on chest X-ray film. Nihon Kyobu Shikkan Gakkai Zasshi. 1991;29(12):1591-1595.
Google Scholar | Medline4. Tanaka, K, Ihaya, A, Horiuci, T, et al. Giant mediastinal bronchial artery aneurysm mimicking benign esophageal tumor: a case report and review of 26 cases from literature. J Vasc Surg. 2003;38(5):1125-1129.
Google Scholar | Crossref | Medline5. Sancho, C, Domínguez, J, Escalante, E, Hernandez, E, Cairols, M, Martinez, X. Embolization of an anomalous bronchial artery aneurysm in a patient with agenesis of the left pulmonary artery. J Vasc Interv Radiol. 1999;10(8):1122-1126.
Google Scholar | Crossref | Medline6. Karmakar, S, Nath, A, Neyaz, Z, Lal, H, Phadke, RV. Bronchial artery aneurysm due to pulmonary tuberculosis: detection with multidetector computed tomographic angiography. Journal of Clinical Imaging Science. 2011;1:26. doi:10.4103/2156-7514.81293.
Google Scholar | Crossref | Medline7. Cheng, YS, Lu, ZW. Bronchial aneurysm secondary to tuberculosis presenting with fatal hemoptysis: a case report and review of the literature. J Thorac Dis. 2014;6(6):E70-E72.
Google Scholar | Medline8. Chung, MJ, Lee, JH, Lee, KS, Yoon, YC, Kwon, OJ, Kim, TS. Bronchial and nonbronchial systemic arteries in patients with hemoptysis: depiction on MDCT angiography. Am J Roentgenol. 2006;186(3):649-655. doi:10.2214/AJR.04.1961.
Google Scholar | Crossref | Medline9. Takahashi, Y, Tsutsumi, Y, Monta, O, et al. Stent grafting for giant bronchial artery aneurysm disguised as an aneurysm with multiple feeding arteries. Ann Thorac Surg. 2010;89(5):1652-1654.
Google Scholar | Crossref | Medline10. Hu, C-x, Huang, S, Xu, Z-w, Chen, W, Huang, J-s, Fu, Z. Combination of aortic stent-graft and arterial embolization for ruptured bronchial artery aneurysm. Ann Thorac Surg. 2011;92(2):e19-e21.
Google Scholar | Crossref | Medline11. Matsumoto, T, Uchida, T, Ono, T, et al. Bronchial artery aneurysm treated using aortic stent graft alone: a case report. Annals of Vascular Diseases. 2017;10(2):152-154. doi:10.3400/avd.cr.16-00091.
Google Scholar | Crossref | Medline12. Aburano, H, Kawamori, Y, Horiti, Y, Kitagawa, K, Sanada, J, Matsui, O. Bronchial artery aneurysm embolization with NBCA. Cardiovasc Intervent Radiol. 2006;29(6):1141-1143.
Google Scholar | Crossref | Medline | ISI13. Panda, A, Bhalla, AS, Goyal, A. Bronchial artery embolization in hemoptysis: a systematic review. Diagn Interv Radiol. 2017;23(4):307-317. doi:10.5152/dir.2017.16454.
Google Scholar | Crossref | Medline

留言 (0)

沒有登入
gif