Elsevier

Clinical Radiology

Volume 66, Issue 5, May 2011, Pages 478-480
Clinical Radiology

Case Report
Pulmonary artery embolization for recurrent haemoptysis in cavitatory sarcoidosis

https://doi.org/10.1016/j.crad.2010.12.009Get rights and content

Introduction

Haemoptysis is rare in sarcoidosis and is usually due to secondary infection, with massive haemoptysis being even rarer. In the majority of cases, bleeding is from abnormal bronchial arteries with only a small proportion being of pulmonary arterial origin. We report a case of successful pulmonary arterial embolization for haemoptysis in a patient with cavitatory sarcoidosis who had previously undergone successful bronchial arterial embolization (BAE). Computed tomography (CT) pulmonary angiography played an important role in assessing the cause of recurrent haemoptysis and in planning the approach to treatment.

Section snippets

Case report

A 41-year-old man with previously well-controlled steroid-responsive cavitatory sarcoidosis presented with a 2 year history of progressive intermittent haemoptysis of up to 100 ml per day. He was commenced on anti-fungal therapy in view of his haemoptysis and positive Aspergillus sp. sputum cultures. An admission chest radiograph revealed air-space changes on the right in keeping with recent haemorrhage.

Bronchial arterial angiography was performed via a 5F right common femoral artery sheath with

Discussion

Massive haemoptysis is variably defined as production of 300–600 ml of blood in 24 h.1, 2, 3 An alternative clinical definition is any haemoptysis that causes haemodynamic or respiratory compromise or results in a haematocrit of less than 0.30 (<30%).3 Tuberculosis (TB) is the leading cause of haemoptysis worldwide with bronchogenic carcinoma, bronchiectasis secondary to chronic inflammatory lung disease, and aspergillomas within pulmonary cavities accounting for most other cases.1, 2, 3, 4, 5, 6

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      Citation Excerpt :

      In sarcoidosis, the formation of mycetomas in preexisting bullae and cysts is associated with hemoptysis, which is the second most common cause of death among these patients.42 BAE provides a parenchyma-sparing option for management of massive hemoptysis and has successfully been used in cavitary sarcoidosis.43,44 Transcatheter embolotherapy is indicated for treatment of PAVMs.

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