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Pulmonary Tuberculosis
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Charles S. Dela Cruz, Barbara Seaworth, Graham Bothamley
Bronchial artery embolization is the first mode of treatment where conservative measures fail to halt the hemoptysis.59 Cannulation of bronchial arteries is technically difficult and requires an experienced interventional radiologist.
Respiratory Tuberculosis
Published in Peter D O Davies, Stephen B Gordon, Geraint Davies, Clinical Tuberculosis, 2014
Bronchial artery embolisation has been reported as a successful management strategy in acute massive haemoptysis, but this treatment relies on demonstration of an actively bleeding vessel and successful occlusion of that vessel in a timely manner using angiography or CT guidance. The success rate of this has been quoted to be around 84%–94% and has reduced the need for surgical intervention for the same [129,130]. The angiographic signs in haemoptysis include hyperplasia of the bronchial artery trunk, broncho pulmonary anastomoses and bronchial artery aneurysms. A risk of the procedure is pulmonary infarction, but this is uncommon due to the anastomoses mentioned. The number of patients successfully treated by bronchial artery embolisation is small.
Proximal pulmonary artery embolization for recurrent hemoptysis after bronchial artery embolization
Published in Baylor University Medical Center Proceedings, 2021
Eric M. Swanson, Brandon Dickey, James Murray, Steven Ruiz
Recurrent hemoptysis occurs in approximately 20% of lung tumor patients, with a 3% incidence of death when hemoptysis is severe.1 Most hemoptysis (>90%) originates from the systemic arteries, with <10% originating from the pulmonary artery (PA).2 The underlying pathology contributing to hemoptysis in lung tumor patients is PA erosion secondary to necrotic tumor processes.3 Currently, bronchial artery embolization is the first-line interventional radiology treatment, with surgical management often used as the definitive treatment in surgical candidates.4 However, in 20% of patients, bleeding will persist after bronchial artery embolization and is associated with high mortality.5 In such cases, PA embolization is indicated to control persistent hemoptysis after bronchial artery embolization5 or in patients with PA erosion.6 Typically, only the segmental or distal branch of the PA contributing to the bleeding is embolized in an attempt to minimize the impact of embolization on pulmonary hemodynamics and maintain perfusion to as much of the lung parenchyma as possible. We present a case of a proximal PA embolization in a lung tumor patient with recurrent hemoptysis after bronchial artery embolization.
Drug-eluting beads bronchial arterial chemoembolization as a neoadjuvant treatment for squamous non-small cell lung cancer
Published in Postgraduate Medicine, 2020
Hemoptysis is a common complication of central squamous cell carcinoma of the lung. As the bronchial artery is also the main source of hemoptysis, bronchial artery embolization is the most effective way to treat hemoptysis [7]. BACE is also very effective in the treatment of lung cancer with hemoptysis [8]. Our patient had locally advanced SNSCLC without driver gene mutations, and his economic condition was poor. Therefore, it was recommended that he be evaluated for surgery after neoadjuvant chemotherapy. The patient refused chemotherapy and did not receive antitumor treatment after discharge until the hemoptysis worsened and he was hospitalized again. Because of the tumor and hemoptysis, we performed DEB-BACE, which caused the hemoptysis to subside and the lung lesions to continue to shrink. The patient finally consented to undergo surgery after the third round of DEB-BACE. No tumor cells were found in the postoperative pathological sections, indicating pCR, which is very rare. Further, there were no obvious AEs of DEB-BACE. Therefore, the treatment effect in this patient was very satisfactory.
Invasive pulmonary aspergillosis secondary to microwave ablation: a multicenter retrospective study
Published in International Journal of Hyperthermia, 2018
Guanghui Huang, Xin Ye, Xia Yang, Chuntang Wang, Licheng Zhang, Guangdong Ji, Kaixian Zhang, Huili Wang, Aimin Zheng, Wenhong Li, Jiao Wang, Xiaoying Han, Zhigang Wei, Min Meng, Yang Ni
Regarding antifungal treatment, 22 cases initially received intravenous voriconazole while one case received itraconazole. Once clinical improvement was demonstrated with intravenous voriconazole, patients were discharged with oral itraconazole (n = 5) or oral voriconazole (n = 17). Six patients required intracavitary lavage due to necrotic liquefaction and five required thoracic drainage due to pleural effusion and bronchopleural fistula. Both procedures were performed via percutaneous catheterization. Bronchial artery embolization was performed in one patient to manage severe hemoptysis. Six patients (26.1%) died before completion of treatment and their treatment responses were categorized as failures. Sudden massive hemoptysis was responsible for a third of the deaths (2/6). Based on clinical and radiological improvement, 17 patients (73.9%) achieved treatment success, including five who died from tumor recurrence or metastasis, rather than IPA. In patients with treatment success, the mean duration of treatment was 44.6 days (vs. 18.5 days in those with treatment failure). Also of note, secondary bacterial infections developed in eight patients during antifungal treatment (Table 5).