Transcatheter Bronchial Artery Embolization in the Multimodality Management of Massive Hemoptysis (1)
Massive hemoptysis is a devastating and sometimes fatal condition. In the past few years, a number of new techniques have emerged, including bronchial blockers, double lumen endotracheal intubation and ventilation, laser therapy, and most recently, transcatheter bronchial artery embolization (TBAE).’ Often, the surgeon must combine these techniques to keep the patient alive while trying to treat definitively the cause of the hemoptysis. The following is a case report that demonstrates the importance of TBAE in the multimodality management of massive hemoptysis. asthma inhalers
A 50-vear-old man presented to a community hospital with ongoing hemoptysis estimated to he approximately 800 ml over a period of several hours. His medical history was significant for a right lung squamous cell carcinoma diagnosed four years previously when he had presented with superior vena cava syndrome. He was treated with curative radiation therapy (6,500 rad) and had done well in the intervening years. On evaluation at the hospital, he was noted to he a robust man in moderate distress coughing up a continuous flow of bright red blood. Bronchoscopy localized the bleeding to the right lung, but hemorrhage was too brisk to identify the source. A No. 6 Fogarty embolectomy catheter was passed into the right main-stem bronchus and inflated, with resultant control of the hemoptysis. He was transferred to Northwestern Memorial Hospital, Chicago, for consideration of more definitive therapy.