The role of bronchial arteriography and therapeutic embolization in hemoptysis

A case is presented which demonstrates the value of bronchial arteriographic studies in localizing and treating hemoptysis. The patient was bleeding from an old posttuberculous bulla and for several reasons was not a candidate for surgery. Bronchial arteriographic studies demonstrated both hypervascularity in the region of the cavity and also a mycotic aneurysm of a bronchial artery. After therapeutic embolization with gelatin (Gelfoam), the hypervascularity and aneurysm were no longer opacified. Active bleeding abruptly ceased and, except for a single mild recurrence, has not recurred during the three months since therapeutic embolization. The major theoretic risk of bronchial arteriographic study and therapeutic embolization is spinal injury. It is believed that permanent injury can almost always be avoided, providing proper technique is used.