Letter to the Editor
Ruptured bronchial artery aneurysm in patient with unknown trauma or lung disease
Ruptura de aneurisma da artéria brônquica em paciente sem traumatismo ou doença pulmonar conhecidos
F. Morais
, V.V. Mascarenhas, P. Campos
Corresponding author
Radiology Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte (CHLN), Lisboa, Portugal
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array:23 [ "pii" => "S0873215913001384" "issn" => "08732159" "doi" => "10.1016/j.rppneu.2013.09.003" "estado" => "S300" "fechaPublicacion" => "2014-03-01" "aid" => "190" "copyright" => "Sociedade Portuguesa de Pneumologia" "copyrightAnyo" => "2013" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Rev Port Pneumol. 2014;20:117" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6461 "formatos" => array:3 [ "EPUB" => 265 "HTML" => 4948 "PDF" => 1248 ] ] "itemAnterior" => array:19 [ "pii" => "S087321591300158X" "issn" => "08732159" "doi" => "10.1016/j.rppneu.2013.08.005" "estado" => "S300" "fechaPublicacion" => "2014-03-01" "aid" => "195" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Rev Port Pneumol. 2014;20:115-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6030 "formatos" => array:3 [ "EPUB" => 277 "HTML" => 4500 "PDF" => 1253 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Bronchial carcinoid tumor presenting with recurrent pneumothorax" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "115" "paginaFinal" => "116" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Tumor carcinóide brônquico apresentado com pneumotórax recorrente" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1503 "Ancho" => 1517 "Tamanyo" => 293633 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">a) Chest radiograph showing a left side pneumothorax (arrows). b) Chest CT showing increased left lung volume with contralateral mediastinum shift and decreased ipsilateral lung attenuation. c) Chest CT showing a 2 cm lesion in the left main bronchus. d) Chest CT, eighteen moths after surgery, showing resolution of the mediastinum shift and similar bilateral lung attenuations.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Reis, L. Nascimento, A. Fernandes" "autores" => array:3 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Reis" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Nascimento" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Fernandes" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087321591300158X?idApp=UINPBA00004E" "url" => "/08732159/0000002000000002/v4_201509041359/S087321591300158X/v4_201509041359/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Ruptured bronchial artery aneurysm in patient with unknown trauma or lung disease" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "117" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F. Morais, V.V. Mascarenhas, P. Campos" "autores" => array:3 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Morais" "email" => array:1 [ 0 => "fatimasmorais@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "V.V." "apellidos" => "Mascarenhas" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Campos" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Radiology Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte (CHLN), Lisboa, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Ruptura de aneurisma da artéria brônquica em paciente sem traumatismo ou doença pulmonar conhecidos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 826 "Ancho" => 1000 "Tamanyo" => 118922 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial CT image showing intrapulmonary ruptured BAA (with 2,4 × 2,4 cm) contained by adjacent right pulmonary parenchyma, associated with homolateral intrapulmonary hematoma and hemothorax.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Enlargement of the bronchial arteries with bleeding, is more prominent in bronchial disease (bronchiectasis or chronic bronchial inflammation), than in chronic parenchymal lung disease.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Normal bronchial arteries are small vessels (less than 2<span class="elsevierStyleHsp" style=""></span>mm) that arise directly from the descending thoracic aorta. There are anatomical variations, but the most constant vessel is the right intercostobronchial trunk, which usually arises from the right posterolateral aspect of the thoracic aorta.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Bronchial artery aneurysm (BAA) is very rare and is reported in less than 1% of selective bronchial arterial angiograms.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We briefly review the literature of BAA based on radiological findings of an exceptional case of an 74 years-old male, with no previous trauma or lung disease, that was admitted to our emergency department with hemoptysis and was found to have ruptured BAA in computed tomography (CT). The chest angio-CT (CT performed with intravenous contrast) revealed a 2.4<span class="elsevierStyleHsp" style=""></span>cm BAA (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) contiguous with a large right bronchial artery, that is originated from the dilated right intercostobronchial trunk, associated intrapulmonary hematoma of the lower right lobe (secondary to sustained ruptured intrapulmonary BAA) and homolateral hemothorax.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">No apparent lung parenchymal or bronchial disease (namely bronchiectasis) was seen.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Thoracotomy with partial inferior right lobectomy was performed, because of the life threatening contained BAA rupture, and confirmed CT findings.</p><p id="par0035" class="elsevierStylePara elsevierViewall">BAA can be congenital (as in the context of pulmonary sequestration or pulmonary agenesis), or can be acquired (as a result of lung disease, trauma, sepsis, vasculitis or Osler–Weber–Rendu syndrome).<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In patients without predisposing pulmonary or systemic disease, BAA are extremely rare.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">BAA are classified anatomically either as mediastinal or intrapulmonary or both, because of their associated symptoms.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Intrapulmonary aneurysms often present hemoptysis and the main complaint for mediastinal BAA is related to compression or rupture into contiguous structures.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Most BAA are asymptomatic until they rupture.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Regardless of whether the patient has symptoms, BAA should be treated promptly when diagnosed, because it is a potentially life-threatening lesion.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Angio-CT is mandatory to make definitive diagnosis of BAA, providing essential information for further treatment approach.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Thoracotomy with surgical extirpation of the aneurysm is one of the approaches, as it is embolization, for treatment of BAA and is indicated in complicated (rupture) BAA cases.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Our case reports a complication of intrapulmonary BAA and was consistent with the extremely rare reports of BAA in patients without lung disease.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 826 "Ancho" => 1000 "Tamanyo" => 118922 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial CT image showing intrapulmonary ruptured BAA (with 2,4 × 2,4 cm) contained by adjacent right pulmonary parenchyma, associated with homolateral intrapulmonary hematoma and hemothorax.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic arterial supply to lungs in adults: spiral CT findings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K.H. 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Douglas" 5 => "M.D. Katz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/AJR.06.0291" "Revista" => array:6 [ "tituloSerie" => "AJR" "fecha" => "2006" "volumen" => "187" "paginaInicial" => "W544" "paginaFinal" => "W545" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17056888" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08732159/0000002000000002/v4_201509041359/S0873215913001384/v4_201509041359/en/main.assets" "Apartado" => array:4 [ "identificador" => "19161" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Cartas ao editor" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08732159/0000002000000002/v4_201509041359/S0873215913001384/v4_201509041359/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215913001384?idApp=UINPBA00004E" ]
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