An unusual cause of hemoptysis: costocervical trunk pseudoaneurysm

Non-bronchial causes of haemoptysis: imaging and interventions

Purpose

To describe non-bronchial causes of haemoptysis on imaging and the role of interventional radiology in their management from cases of haemoptysis archived from our database at a tertiary care, federally funded institution.

Material and methods

Retrospective analysis of cases that presented with haemoptysis in our institution from 2008 to 2013 was done, and details of cases in which the bleeding was from a non-bronchial source were archived and details of imaging and treatment were recorded.

Results

Retrospective analysis of patients presenting with haemoptysis yielded 24 (n = 24) patients having haemoptysis from non-bronchial sources. Causes of haemoptysis were: Rasmussen aneurysms (n = 12/24), costocervical trunk pseudoaneurysm (n = 1/24), left internal mammillary artery pseudoaneurysm (n = 1/24), left ventricular aneurysms (n = 3/24), pulmonary arteriovenous malformations (AVMs) (n = 5/24), and proximal interruption of pulmonary artery (n = 2/24). Imaging and interventional radiology management are described in detail.

Conclusions

Haemoptysis can be from non-bronchial sources, which may be either from systemic or pulmonary arteries or cardio-pulmonary fistulas. Bronchial computed tomography angiography (CTBA), if feasible, must always be considered before bronchial artery embolisation because it precisely identifies the source of haemorrhage and vascular anatomy that helps the interventional radiologist in pre-procedural planning. This circumvents chances of re-bleed if standard bronchial artery embolisation is done without CTBA.

Intercostal artery pseudoaneurysm in pulmonary tuberculosis - A rare cause of hemoptysis: A case report with review of the literature

Pulmonary tuberculosis (TB) is one of the common causes of life-threatening hemoptysis, particularly in developing countries. Bronchial and pulmonary arteries are the major source of hemoptysis in pulmonary TB. Intercostal artery pseudoaneurysm as a cause of hemoptysis in pulmonary TB is extremely rare, with only a few reported cases. We describe a case of intercostal artery pseudoaneurysm in a patient of pulmonary TB, presenting as massive hemoptysis. Computed tomography bronchial angiography (CTBA) revealed a contrast-filled outpouching in a left upper lobe cavity. Catheter angiography revealed a pseudoaneurysm arising from one of the left intercostal arteries, which was managed subsequently by endovascular embolization. Pseudoaneurysm from visceral arteries is an extremely rare but important cause of massive hemoptysis in pulmonary TB, which if not managed promptly may prove fatal.

Endovascular coil embolization of a costocervical trunk pseudoaneurysm after bullectomy with pleural abrasion

Transarterial embolization (TAE) is less invasive than surgery for the treatment of pseudoaneurysms. Costocervical trunk (CCT) pseudoaneurysms are extremely rare. We herein report an unusual case of a 45-year-old man with a CCT pseudoaneurysm caused by a bullectomy with pleural abrasion, which had been performed to manage a spontaneous pneumothorax. The patient presented with chronic chest pain and successfully underwent TAE with a metallic coil. The chest pain completely disappeared 2 weeks after the TAE, and follow-up computed tomography showed that the pseudoaneurysm had almost completely disappeared 9 months after the TAE.