Register for email alerts and news feeds:
This journal | BMJ Group
rss
Thorax 2004;59:912; doi:10.1136/thx.2004.028589
Copyright © 2004 BMJ Publishing Group Ltd & British Thoracic Society.
Thorax 2004;59:912
© 2004 BMJ Publishing Group Ltd & British Thoracic Society

Images in Thorax

A rare presentation of a ruptured bronchial artery aneurysm

A Chatterjee1, S Ghosh1, K Salhiyyah1, P Gaines2, G Rocco3

1 Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield S5 7AU, UK
2 Department of Vascular Radiology, Northern General Hospital, Sheffield S5 7AU, UK
3 Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield S5 7AU, UK

Correspondence to:
Correspondence to:
Mr S Ghosh
Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield S5 7AU, UK; sudip.ghosh{at}talk21.com

A fit 59 year old man with no past medical history of respiratory diseases presented with chest pain and bilateral pleural effusions. On arrival at the specialist thoracic unit his haemoglobin was 7.2 g/l. A CT scan (fig 1Go) and selective arteriography (fig 2Go) confirmed an acute bilateral haemothorax secondary to a ruptured bronchial artery aneurysm of the distal segment of the right bronchial artery just below the level of the carina. The patient was treated with bilateral intercostal chest drainage and the aneurysm was successfully treated with coil embolisation. He was discharged home on day 8 and a repeat CT scan before his discharge revealed almost total regression of the haemothoraces and no enhancement of the aneurysm.



View larger version (111K):
[in this window]
[in a new window]
 

Figure 1  Contrast enhanced CT scan at the subcarinal level showing a focal round area of increased attenuation (arrow) adjacent to the bronchus intermedius.

 



View larger version (116K):
[in this window]
[in a new window]
 

Figure 2  Selective arteriogram of the right bronchial artery showing a saccular aneurysm arising from the distal segment of the right bronchial artery.

 


Learning points

  • Bronchial artery aneurysm should be considered as differential diagnosis of acute bilateral haemothorax.
  • If the patient is stable, first line management should be radiologically guided coil embolisation.
  • Surgery should be reserved for patients in whom embolisation is contraindicated (allergy to iodinated contrast medium, existence of medullary artery) and in cases where anatomical configuration makes complete and definitive embolisation of the aneurysm impossible.



Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?

This Article

Services
Citing Articles
Google Scholar
PubMed
Topic Collections
Bookmark with

Register for free content

The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

Chest Medicine Jobs

Chest Medicine Jobs

Show me all >>