Racemose hemangioma revealed by massive intraoperative hemorrhage: A case report

INTRODUCTION AND IMPORTANCE: Bronchial arterial racemose hemangioma is considered to be a type of pulmonary arteriovenous malformation (PAVM). We encountered an extremely rare case of racemose hemangioma, which was identified because of massive bleeding during lung cancer surgery. CASE PRESENTATION: A 71-year-old man was suspected of having lung cancer and underwent a right upper lobectomy. During the dissection of the peribronchial connective tissue around the upper lobe bronchus, a sudden massive hemorrhage occurred after separation of the pulmonary artery and vein. Hemostasis was difficult to achieve with compression hemostasis and the point of bleeding was unknown; thus, we were called in to search for the source of the bleeding, which was identified as the bronchial artery. Postoperatively, a racemose hemangioma was diagnosed via preoperative chest computed tomography and imaging analysis with the Ziostation2® (Ziosoft Inc. Tokyo, Japan). CLINICAL DISCUSSION: Racemose hemangioma has weaker blood vessel walls than normal blood vessels. Once bleeding occurs, it is very difficult to stop. However, once the bleeding point was identified, hemostasis via suturing and cutting was possible. CONCLUSION: As hemorrhaging from a racemose hemangioma is very difficult to stop, preoperative imaging retrieval is very important.