Chest Imaging

Embolization, bronchial arteries

an endovascular treatment commonly used for treating haemoptysis (see haemoptysis endovascular treatment). It consists of occluding the systemic supply to the lung, either bronchial or nonbronchial or both, with nonresorbable particles (Fig.1). The main indication for an endovascular approach to bronchial bleeding is where medical treatment has failed and surgical treatment is temporarily or absolutely contraindicated. Embolization requires a perfect knowledge of the anatomy of the systemic supply to the lung. The treatment should be undertaken during the registration of somato-sensory evoked potentials. Opacification of the anterior spinal artery at the cervicothoracic junction arising from the intercostobronchial trunk or another intercostal artery is an absolute contraindication to embolization. Obliteration of an antegrade systemicopulmonary shunt by embolization, an occult pulmonary artery, chronic thromboembolic disease or intralobar vascular sequestration, can release an aseptic pulmonary infarct. Although very rare, haemoptysis of pulmonary arterial origin should be taken into consideration whenever a necrotic bronchoinvasive or angioinvasive process of the lung triggers the bleeding. Apart from haemoptysis, embolization of the systemic supply can be considered in the following conditions:

  • transthoracic drainage and surgery of intracavitary aspergilloma in order to avoid trauma to the transpleural systemic arteries and intracavitary haemorrhage;

  • preoperative management of hypervascularized tumours of the chest wall, pleura, lung and mediastinum;

  • scimitar syndrome with large systemic arteries to the right lung (embolization is aimed at lowering the pulmonary hypertension due to the left to right shunt from the systemic arteries to right atrium via the scimitar vein. The systemic supply also has to be evaluated before reimplantation of the scimitar vein in the left atrium or before surgery of the left lung which can increase the contralateral shunt); and

  • intralobar sequestration, provided that the lung in the sequestrated area is normal.

    JR - MRJ

    • To view high resolution images,
    please register first.

    Click  here to register.

    Already registered? Enter your e-mail in the window below.
    Re-register

    Fig.1

    Profuse bronchial hypervascularization of the right upper lobe in a patient with intracavitary aspergilloma (left). Complete cessation of bleeding was obtained after bronchial artery embolization (right).
    Embolization, bronchial arteries, Fig.1