E2520. Uncommon Causes of Hemoptysis: A Case Series
  1. Stephen Himmelberg; University of North Carolina
  2. Marinelda Perlleshi; University of North Carolina
  3. Clayton Commander; University of North Carolina
Massive hemoptysis stems from both benign and malignant disease. With up to 14% of cases of hemoptysis being classified as massive, this imposes a large risk for death and severe morbidity among this patient population. While bronchial arteries are the source of bleeding in up to 90% of cases in the United States, non-bronchial sources of hemoptysis can present a diagnostic and therapeutic challenge. This educational exhibit will review uncommon (non-bronchial) sources of hemoptysis. We will focus on pathophysiology, diagnosis, and treatment. For each case we will demonstrate how scrutiny of the pre-procedure diagnostic CT helped guide the subsequent intervention. After reviewing this exhibit, the reader will have a better understanding of the evaluation and management of uncommon causes of hemoptysis.

Educational Goals / Teaching Points
Defining hemoptysis, pulmonary blood supply, pathophysiology overview, diagnostic/localizing the bleeding source, bronchial artery embolization, management of non-bronchial hemoptysis, recurrence, five case illustrations of uncommon causes of hemoptysis, and conclusions.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Following our first seven teaching points our case series consists of five cases of hemoptysis involving a variety of pathophysiology. We will include a pulmonary artery hemorrhage secondary to a Rasmussen’s aneurysm, a ruptured pulmonary arteriovenous malformation, a gastroepiploic artery hemorrhage following esophagectomy and pull-through, an internal thoracic-to-pulmonary artery fistula following a case of necrotizing pneumonia, and an intercostal artery pseudoaneurysm resulting in hemoptysis following thoracic surgery. For each case, we will highlight diagnostic and angiographic imaging correlates and discuss the subsequent treatment plan.

This case series and educational exhibit highlight a variety of non-bronchial causes of hemoptysis. The first two cases demonstrate two pulmonary arterial sources – a large proximal pseudoaneurysm excluded with a stent-graft and a ruptured arteriovenous malformation embolized with coils. Two post-surgical cases were also included as well as an internal thoracic artery-to-pulmonary artery fistula in the setting of pneumonia. For each case we highlight key findings from the pre-intervention diagnostic imaging studies which aided the subsequent intervention. For each case, we discuss the treatment method and choice of embolic.