Six Cases of Hemoptysis with Angiogenesis from Non-Bronchial Systemic Arteries

Case series Patients: Male, 73-year-old • Female, 79-year-old • Male, 45-year-old • Male, 76-year-old • Female, 63-year-old • Male, 43-year-old Final Diagnosis: Aspergillus fumigatus infection • hereditary haemorrhagic telangiectasia • lymphangioleiomyomatosis • tuberculosis Symptoms: Hemoptysis Medication: — Clinical Procedure: Angiography • CT scan • embolization Specialty: Pulmonology • Radiology OBJECTIVE: Unusual clinical course BACKGROUND: Although bronchial arteries are the most common cause of hemoptysis, other systemic arteries can cause hemoptysis and are potential pitfalls for successful embolization. CASE REPORTS: We present 6 cases of hemoptysis showing vascularization from systemic arteries other than bronchial arteries that presented to our department between 2013 and 2020. Chronic inflammatory diseases such as tuberculosis and pulmonary aspergillosis were the underlying diseases in 4 of the 6 cases. In all 6 cases, the lesions were close to the pleura. The abnormal non-bronchial systemic arteries were the internal thoracic artery in 4 cases, intercostal artery in 2 cases, lateral thoracic artery in 2 cases, and the subclavian, thyrocervical, and inferior phrenic arteries in 1 case each, all of which formed a shunt with the pulmonary artery. Additionally, depending on the location of the lesion, the non-bronchial systemic arteries near the lesion proliferated into the lung parenchyma through the adherent pleura. CONCLUSIONS: When lesions are in contact with the pleura, various non-bronchial systemic arteries near the lesion can develop in the pulmonary parenchyma via the adherent pleura, which can cause hemoptysis. In patients with hemoptysis, it may be useful to evaluate chest contrast-enhanced computed tomography and angiography, while always accounting for the potential involvement of non-bronchial systemic arteries to ensure a safer and more reliable treatment.