Embolisation of a Bronchial Artery of Anomalous Origin in Massive Haemoptysis
Journal name: The Malaysian Journal of Medical Sciences
Original article title: Embolisation of a Bronchial Artery of Anomalous Origin in Massive Haemoptysis
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Ahmad Razali Md Ralib, Ng Teck Han, How Soon Hin, Ahmad Sobri Muda
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: Embolisation of a Bronchial Artery of Anomalous Origin in Massive Haemoptysis
Year: 2010
Copyright (license): CC BY 4.0
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Summary of article contents:
Introduction
Massive haemoptysis, defined as a pulmonary haemorrhage of 500–600 ml within 24 hours, presents significant risks and challenges in emergency respiratory care. Bronchial artery embolisation (BAE) has emerged as an effective treatment for managing massive and recurrent haemoptysis, boasting a success rate ranging from 88% to 100%. However, identifying the source of bleeding can be complicated by anomalous origins of bronchial arteries, which may go unrecognized during initial diagnostic imaging procedures. This report details a case of massive haemoptysis due to lung carcinoma where the bronchial artery had an atypical origin directly from the right subclavian artery, highlighting the importance of thorough anatomical knowledge in interventional radiology.
Bronchial Artery of Anomalous Origin
A 58-year-old female patient with a history of lung carcinoma experienced a critical episode of massive haemoptysis. Initially, standard imaging failed to identify the bleeding source, as the flush thoracic aortogram did not reveal any irregularities in the normally expected bronchial arteries. Subsequent imaging of the right subclavian artery successfully located a dilated right bronchial artery emanating from this artery, which was successfully embolised using 15% diluted glue. The process not only controlled the immediate bleeding but also illustrated the need for interventional radiologists to maintain a high level of suspicion for bronchial arteries with anomalous origins when conventional imaging techniques fall short.
Conclusion
The case underscores the necessity for interventional radiologists to be well-versed in variations of bronchial artery anatomy, particularly concerning anomalous origins. An atypical bronchial artery should be considered when conventional imaging fails to pinpoint the source of massive haemoptysis, as persistent or recurrent bleeding may indicate incomplete embolisation or unrecognized vascular routes. Ultimately, awareness of these anatomical variations and the potential need for alternative treatment strategies, such as using varying embolic materials like diluted glue, can enhance patient outcomes during critical respiratory interventions.
FAQ section (important questions/answers):
What is massive haemoptysis and why is it concerning?
Massive haemoptysis is defined as a pulmonary haemorrhage of 500–600 ml in 24 hours. It is a critical respiratory emergency requiring urgent medical intervention due to its potential to cause respiratory failure and hemodynamic instability.
What is bronchial artery embolisation (BAE) and its purpose?
BAE is a medical procedure used to manage massive and recurrent haemoptysis. It involves blocking the bronchial arteries supplying the bleeding source, which can successfully control the hemorrhage, with reported efficacy rates between 88% and 100%.
What challenges do anomalous origin bronchial arteries pose?
Anomalous origin bronchial arteries can complicate the diagnosis and treatment of haemoptysis, as they may not be visualized during conventional angiograms, leading to persistent bleeding even after embolization.
How was the right bronchial artery successfully embolized in the case?
In the reported case, the right bronchial artery, originating from the right subclavian artery, was successfully embolized using 15% diluted glue, following a selective arteriogram to confirm its location and ensure effective treatment.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Embolisation of a Bronchial Artery of Anomalous Origin in Massive Haemoptysis”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Arrow:
In the context of the case report, 'Arrow' refers to the arrows used in imaging studies (like angiograms) that point to specific anatomical structures or findings. These visual cues assist radiologists and interventionalists in identifying anomalies, such as the anomalous origin of the bronchial artery, facilitating targeted interventions during procedures like bronchial artery embolisation.
2) Radiotherapy:
'Radiotherapy' denotes the treatment of cancer using focused radiation to destroy cancer cells or shrink tumors. In this case, after bronchial artery embolisation to control massive haemoptysis, the patient's lung carcinoma was treated with radiotherapy, showcasing its importance in managing malignancies as part of a multidisciplinary treatment approach for lung cancer.
3) Blood:
'Blood' is a crucial component in the context of massive haemoptysis. The rapid loss of blood in substantial amounts signifies a medical emergency. The management of blood loss is paramount, making interventions like bronchial artery embolisation essential in controlling the source of the bleeding to stabilize the patient and reduce respiratory and hemodynamic complications.
4) Life:
'Life' in this medical context underscores the urgency and critical nature of responding to emergencies like massive haemoptysis. The preservation of life is the primary goal in all medical interventions, including the use of bronchial artery embolisation, highlighting the profound responsibility of healthcare providers to effectively manage potentially life-threatening situations.
5) Chemotherapy:
'Chemotherapy' refers to the administration of cytotoxic drugs to treat cancer. In the provided case, the patient with lung carcinoma underwent chemotherapy but experienced complications such as thrombosis. This necessitated emergent interventions. The interplay between chemotherapy and managing side effects is critical in cancer treatment, influencing patient outcomes and subsequent conditions like massive haemoptysis.
6) Post:
'Post' signifies the time period after an initial medical event or intervention. In this case, it refers to the condition of the patient following embolisation and subsequent treatments. The term highlights the monitoring of complications and disease progression, which is essential to understanding a patient’s recovery trajectory and planning further interventions, such as radiotherapy.
7) Pur (Pūr):
'Poor' typically describes the quality or status of health, such as 'poor pulmonary reserve' noted in patients with lung disease. This term warns of the increased risk related to surgical interventions or the potential challenges in managing conditions like massive haemoptysis, necessitating careful consideration of treatment options like bronchial artery embolisation over more invasive procedures.
8) Knowledge:
'Knowledge' is fundamental for interventional radiologists in understanding complex anatomy and pathology. Adequate knowledge of bronchial artery anatomy—including anomalous origins—enables accurate diagnosis and intervention in cases like massive haemoptysis. This expertise directly correlates with patient outcomes, emphasizing the importance of continual education and training in medical practice.
9) Bleeding:
'Bleeding' directly correlates with the clinical scenario of massive haemoptysis. It signifies uncontrolled blood loss leading to critical health crises. Identifying and managing the underlying cause of the bleeding is vital to preventing severe morbidity and mortality, exemplifying the urgency of procedures like bronchial artery embolisation in emergent settings.
10) Disease:
'Disease' pertains to the underlying conditions that necessitate medical attention, such as lung carcinoma in the reported case. Understanding diseases such as cancer is essential for formulating effective treatment plans, guiding the choice of interventions like chemotherapy, radiotherapy, or embolisation to manage complications like massive haemoptysis and improve overall patient prognosis.
11) Water:
'Water' refers to the medium used in medical interventions for flushing and diluting substances. In the context of glue embolisation, water-soluble contrast agents mix with various materials to prevent blockages and facilitate proper deployment of embolic agents, highlighting the critical details in procedural techniques in interventional radiology for managing vital conditions.
12) Field:
'Field' refers to the area of expertise or study within medicine. In this context, it underscores the interventional radiology field involving techniques such as BAE. Professionals in this field must possess specialized skills to address complex cases of massive haemoptysis, ensuring they can navigate relevant anatomical and procedural challenges effectively.
13) Study (Studying):
'Study' indicates research or observational learning applied in medical practices. It relates to the ongoing collection of data and outcomes from patients undergoing treatments, like bronchial artery embolisation, providing valuable insights that contribute to refining procedures, improving patient care, and broadening the medical community's understanding of managing complex conditions involving haemoptysis.
14) Mast:
'Mast' references the healthcare professional role, often related to 'mast' in mast cells in immunology, signaling that systemic conditions or reactions could influence clinical decisions. In a broader context, it may represent the interdisciplinary nature of tackling diseases like lung carcinoma, where multiple specialties collaborate for optimal patient management in complex cases.
Other Science Concepts:
Discover the significance of concepts within the article: ‘Embolisation of a Bronchial Artery of Anomalous Origin in Massive Haemoptysis’. Further sources in the context of Science might help you critically compare this page with similair documents:
Radiotherapy, Computed tomography scan, Intensive care unit, Hemiparesis, Bronchoscopy, PVA, Large cell carcinoma, Right subclavian artery, Pulmonary haemorrhage, Haemoptysis, Soft tissue mass, Hemodynamic instability, Sandwich technique.