Abstract
Background. Massive hemoptysis, a life-threatening condition, requires adequate and prompt treatment. We describe such a case in which bronchial artery embolization (BAE) was unsuccessful and rescue was performed by repetitive endobronchial embolization. Case. A 83-year-old man under treatment for non-tuberculous mycobacterial infection was transferred to our hospital because of massive hemoptysis. Emergency bronchoscopy under general anesthesia revealed active bleeding from the right middle lobe bronchus, and we stopped bleeding temporarily by spraying thrombin via the bronchoscope. Sequentially performed bronchial artery embolization (BAE) was successful in controlling hemoptysis, which was confirmed by bronchoscopy. However, massive hemoptysis recurred on the next day. The event prompted us to perform bronchial embolization (B^5) by using an endobronchial Watanabe spigot (EWS) and a metallic coils, resulting in excellent control of the hemoptysis. The patient has been free from hemoptysis after the procedure. Conclusion. Bronchoscopy under general anesthesia was useful in identifying the bleeding point safely, controlling bleeding temporarily, and facilitating BAE. Moreover, the effect of BAE was easily confirmed directly by bronchoscopy. For cases in which BAE was unsuccessful, like our case (accounting for more than 10%), bronchial embolization should be performed immediately. In managing cases of massive hemoptysis, bronchoscopy under general anesthesia followed by BAE is essential. However, bronchial embolization is also required in a certain percentage of cases that are unsuccessfully treated.
