CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2018; 28(04): 476-479
DOI: 10.4103/ijri.IJRI_162_18
Intervention Radiology

Dealing with technical challenges in embolization of a rare aberrant left inferior bronchial artery arising from the left gastric artery in a patient with massive hemoptysis

Gaurav Gangwani
Departments of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
,
Ajit Yadav
Departments of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
,
Amit Dhamija
Departments of Interventional Chest Medicine, Sir Ganga Ram Hospital, New Delhi, India
,
Arun Gupta
Departments of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
› Author Affiliations

Subject Editor: Financial support and sponsorship Nil.

Abstract

Bronchial artery embolization is an established intervention for management of recurrent massive hemoptysis in a majority of patients. The source of bleeding in a majority of cases is systemic arteries – orthotopic bronchial arteries, anomalous bronchial arteries, or nonbronchial systemic collaterals. We report a case of an aberrant left inferior bronchial artery arising from the left gastric artery (LGA) in a patient with massive hemoptysis. Such origin from infradiaphragmatic vessels and specially left gastric arteries is very rare and needs to be considered by interventional radiologists and pulmonologists in case with hemoptysis disproportionate to supply by orthotopic arteries. Technical challenges were present in the present case in the form of an aneurysm in the aberrant artery and nontarget hepatic and gastric branches arising from LGA. Appropriate selection of hardware and embolic agents was done to deal with the clinical situation.



Publication History

Article published online:
26 July 2021

© 2018. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 
  • References

  • 1 Yoon W, Kim JK, Kim YH, Chung TW, Kang HK. Bronchial and nonbronchial systemic artery embolization for life-threatening hemoptysis: A comprehensive review. Radiographics 2002; 22: 1395-409
  • 2 Marshall TJ, Jackson JE. Vascular intervention in the thorax: Bronchial artery embolization for haemoptysis. Eur Radiol 1997; 7: 1221-7
  • 3 Sancho C, Escalante E, Domínguez J, Vidal J, Lopez E, Valldeperas J. et al. Embolization of bronchial arteries of anomalous origin. Cardiovasc Intervent Radiol 1998; 21: 300-4
  • 4 Cohen AM, Doershuk CF, Stern RC. Bronchial artery embolization to control hemoptysis in cystic fibrosis. Radiology 1990; 175: 401-5
  • 5 McPherson S, Routh WD, Nath H, Keller FS. Anomalous origin of bronchial arteries: Potential pitfall of embolotherapy for hemoptysis. J Vasc Interv Radiol 1990; 1: 86-8
  • 6 Webb WR, Jacobs RP. Transpleural abdominal systemic artery-pulmonary artery anastomosis in patients with chronic pulmonary infection. AJR Am J Roentgenol 1977; 129: 233-6
  • 7 Sellars N, Belli AM. Non-bronchial collateral supply from the left gastric artery in massive haemoptysis. Eur Radiol 2001; 11: 76-9
  • 8 In HS, Bae JI, Park AW, Kim YW, Choi SJ. Bronchial artery arising from the left gastric artery in a patient with massive haemoptysis. Br J Radiol 2006; 79: e171-3
  • 9 Jiang S, Sun XW, Yu D, Jie B. Aberrant left inferior bronchial artery originating from the left gastric artery in a patient with acute massive hemoptysis. Cardiovasc Intervent Radiol 2013; 36: 1420-3
  • 10 Shapiro AL, Robillard GL. The esophageal arteries their configurational anatomy and variations in relation to surgery. Ann Surg 1950; 131: 171-85
  • 11 Hélénon CH, Chatel A, Bigot JM, Brocard H. Left esophago-bronchial fistula following bronchial artery embolization. Nouv Presse Med 1977; 6: 4209
  • 12 Hsu HK, Su JM. Giant bronchoesophageal fistula: A rare complication of bronchial artery embolization. Ann Thorac Surg 1995; 60: 1797-8
  • 13 Munk PL, Morris DC, Nelems B. Left main bronchial-esophageal fistula: A complication of bronchial artery embolization. Cardiovasc Intervent Radiol 1990; 13: 95-7