A 58-Year-Old Woman with Recurrent Hemoptysis after Successful Bronchial Artery Embolization

Massive hemoptysis is a life-threatening complication of respiratory disease. It is an emergency requiring immediate medical attention. A 58 year-old woman with bronchiectasis was admitted to the hospital following episodes of massive hemoptysis. Chest CT scan and bronchoscopy did not reveal any endobronchial lesion and bronchial artery angiography and embolization were performed successfully. Despite successful embolization, her hemoptysis recurred and the patient underwent angiography for the 2(nd) time; which showed normal left bronchial artery and occluded right intercostobronchial artery. Lower thoracic aortogram revealed a systemic non-bronchial artery in the right lower lung field and evidence of pulmonary shunting. Super-selective angiogram of this artery showed vascularity to lower esophagus and considerable supply of the right lower lung field with pulmonary vascular shunting. Embolization of this non-bronchial systemic artery was carried out successfully with complete occlusion. Few days after the embolization, the patient reported pleuritic and epigastric pain and also complained of odynophagia and dysphagia; which were managed conservatively. Four days later, her symptoms improved and she was discharged subsequently. At 40-day follow up, she was still symptom-free with no hemoptysis.