□
PICTURES IN CLINICAL MEDICINE
□
Ruptured Aneurysm Associated with Bronchial Arteriovenous Malformation Masakazu Nabeta 1, Masamichi Koganemaru 2, Osamu Takasu 1 and Toshi Abe 2 Key words: bronchial artery, arteriovenous malformation, aneurysm, rupture (Intern Med 55: 849-850, 2016) (DOI: 10.2169/internalmedicine.55.5778)
Picture 1.
Picture 2.
１
Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, Japan and ２Department of Radiology, Kurume University School of Medicine, Japan Received for publication May 18, 2015; Accepted for publication July 26, 2015 Correspondence to Dr. Masamichi Koganemaru,
[email protected]
849
Intern Med 55: 849-850, 2016
DOI: 10.2169/internalmedicine.55.5778
Picture 3. Picture 4.
A 66-year-old man presented with sudden-onset respiratory discomfort. A chest radiograph revealed a massive area of opacity in the right upper lung zone (Picture 1), and computed tomography demonstrated a large mediastinal hematoma and right bronchial artery aneurysm (BAA), which was suspected to have ruptured. Therefore, angiography was performed to treat the hemorrhage. Bronchial artery angiography clearly showed an enlarged bronchial artery and several aneurysms (Picture 2A). An angiogram also disclosed vascular blush between the distal bronchial artery and pulmonary vein (Picture 2B), suspected to indicate bronchial arteriovenous malformation (AVM). Bronchial artery embolization was performed with microcoils and n-butyl-2-cyanoacrylate (Picture 3), and the patient was discharged one month after the procedure. One year after embolization, a chest radiograph revealed a clear reduc-
tion in the hematoma (Picture 4). BAA associated with bronchial AVM is extremely rare (1, 2). The BAAs noted in this case likely resulted from vessel stress owing to overload caused by the arteriovenous shunt followed by rupture. The authors state that they have no Conflict of Interest (COI).
References 1. Uchiyama D, Fujimoto K, Uchida M, et al. Bronchial arteriovenous malformation: MDCT angiography findings. AJR Am J Roentgenol 188: W409-W411, 2007. 2. Miyoshi K, Moriyama S, Nawa S. Bronchial arteriovenous malformation with large aneurysm, resected by video-assisted thoracic surgery. Gen Thorac Cardiovasc Surg 57: 162-165, 2009.
Ⓒ 2016 The Japanese Society of Internal Medicine http://www.naika.or.jp/imonline/index.html
850
