Embolization of the Left Bronchial Artery in Massive Hemoptysis Secondary to Pulmonary Tuberculosis

Abstract

Introduction: Hemoptysis is the oral expulsion of blood originating from the pulmonary arteriovenous system. It can cause from scarce bleeding to life-threatening bleeding requiring emergent interventions. In our environment the most common cause of massive hemoptysis is pulmonary tuberculosis. The first line of management for this condition is the interventional radiology approach; bronchial artery angioembolization has shown high success rates.

Objective: To present the case of a 32-year-old man with tuberculosis and massive hemoptysis who underwent two bronchial artery angioembolizations.

Case presentation: A 32-year-old male patient with signs and symptoms of systemic inflammatory response was admitted to the Emergency Department for sudden onset hemoptysis. The diagnosis of pulmonary tuberculosis was confirmed by computed tomography and microbiological tests.

Results: A first angioembolization of the bronchial artery was attempted but could not be completed due to anatomical irregularities, risk of procedural complications and hemodynamic instability during the procedure, which required cardiopulmonary resuscitation. After stabilization of the patient, the procedure was performed in a second attempt. The patient was able to be transferred without complications out of the Intensive Care Unit.

Conclusions: Massive hemoptysis in patients with pulmonary tuberculosis is a feared complication, given the high mortality if appropriate interventions are not performed. This case could be performed successfully, despite the low availability of resources and the inadvertent complication during the first procedure.