Methods in Experimental Pathology of Pulmonary Vasculature
Joan Gil in Models of Lung Disease, 2020
Most lung diseases alter bronchial blood flow. Because the bronchial tree is the first pulmonary line of defense from the external environment, inhaled or regurgitated material first lodges in the bronchial mucosa. This is exclusively supplied by the bronchial circulation, which therefore plays an important role in airway disease. The bronchial circulation, which normally forms 1% of the cardiac output, can increase up to one-third the cardiac output in disease states that call for an increased circulation, such as inflammation, scar tissue, hypoxia, intravascular thrombosis, emboli, edema, and congenital heart disease (Allanby et al., 1950; Aziz et al., 1977; Lacina et al., 1983; Liao et al., 1985; Weibel, 1960). Primary or secondary lung neoplasms are supplied by the bronchial circulation (Cudkowicz, 1967; Milne, 1967). It seems that new tissue prefers the higher oxygenation of the bronchial system. Bronchial artery to pulmonary artery anastomosis occurs in the wall of large airways. These are usually closed but they open up when flow in the pulmonary arterial system is reduced or when bronchial blood flow increases in disease. In many disease states, the bronchial circulation has not received the attention it deserves and descriptions of the structural alterations are few.
Respiratory Tuberculosis
Peter D O Davies, Stephen B Gordon, Geraint Davies in 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.
Clinical Diagnosis of Pulmonary Neoplasms
Philip T. Cagle, Timothy C. Allen, Mary Beth Beasley in Diagnostic Pulmonary Pathology, 2008
The history and physical examination is the single most important part of the assessment of a patient with lung cancer. No imaging modality, laboratory assessment, or new technology can replace the physical exam. The patient must be examined completely, and every organ system must be reviewed to eliminate the involvement of other systems. Cancers from other primary sites often metastasize to the lungs. This is because the body’s entire blood volume must pass through the lungs and cancer cells from other primary sites are often trapped in the pulmonary capillaries. Bronchial artery tumor embolization is noted much less frequently (5).
Massive hemoptysis managed by rescue extracorporeal membrane oxygenation
Published in Baylor University Medical Center Proceedings, 2018
Tiana R. Endicott-Yazdani, Christopher Wood, Andrew D. Trinh, Adan Mora
The cardiothoracic team was called to initiate veno-venous ECMO in the emergency department, and the patient’s oxygenation and shock improved, allowing for transfer to the intensive care unit. The endotracheal tube was exchanged to a larger size and a bronchoscopy was performed. She had a large, completely occlusive right main stem bronchus clot (Figure 2a). She was suspected to still be bleeding, so the clot was cleared to identify the bleeding source—active brisk bleeding from the right upper lobe in the B1 airway (Figure 2b). Interventional radiology was consulted. She was found to have an arterial-arterial and arterial-venous fistula in the right upper lobe (Figure 2c). A coil was placed in the feeding artery and beads were injected in the right bronchial artery (Figure 2d). She had hemodynamic recovery and ECMO was stopped after 50 hours, without systemic heparin being given. The vent was removed after 96 hours, and the patient was discharged home completely neurologically intact after 13 days. She was fortunate to not sustain any additional complications and had no bleeding issues postembolization.
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.
Ultra-central lung tumors: safety and efficacy of protracted stereotactic body radiotherapy
Published in Acta Oncologica, 2021
Joyce E. Lodeweges, Peter S. N. van Rossum, Marcia M. T. J Bartels, Anne S. R. van Lindert, Jacqueline Pomp, Max Peters, Joost J. C. Verhoeff
At the time of analysis, 45 patients (63%) had died. No information on the cause of death was available in 7 patients (10%) who survived 8–41 months. Of the latter, only one patient had manifested grade 3 toxicity. Seventeen patients (24%) died of the consequences of lung cancer and 11 patients (15%) as a result of causes unrelated to lung cancer. Possible treatment-related death was seen in 10 patients (14%) who all died of bronchopulmonary hemorrhage. This was observed at a median time after start of treatment of 11 months (range 8–21 months). All 10 patients had a PTV overlapping the main bronchus. Autopsy performed in 2 cases revealed a bronchial fistula between the main bronchus of the right lower lobe and the bronchial artery in one patient and a fistula between the main bronchus and the pulmonary artery in the other patient. These fistulas were both located in the high dose radiation area and due to ulceration and necrosis of the bronchus. One of 10 patients started with bevacizumab 2 months after SBRT for the lung because of synchronous diagnosed rectal cancer and developed fatal bronchopulmonary hemorrhage 6 months later. Among the patients with fatal bronchopulmonary hemorrhage, 6 patients (60%) used anticoagulant or antiplatelet drugs during SBRT, compared to 31 (50%) of 62 patients who did not die of bronchopulmonary hemorrhage (p = 0.736). Tumor histology was not significant associated with fatal bronchopulmonary hemorrhage (p = 0.094).