CLINICAL CASE OF RIGHT LUNG ANGIODYSPLASIA WITH RECURRENT PULMONARY BLEEDING

Background. Massive pulmonary hemorrhage (grade IIIA-IVB according to the classification of Grigoriev) is a difficult problem for both ambulance teams and specialized hospitals. The mortality rates 50 % or more. Death at the top of hemorrhagic attack follows mainly from flooding of the respiratory tract with blood and asphyxia. Malformation of the lung bloodstream (angiodysplasia, angiomatosis) as the cause of pulmonary hemorrhage is a real challenge for treatment because of multiple sources of bleeding. Effective endovascular hemostasis and prevention of recurrent pulmonary hemorrhage are possible, provided that all blood vessels supplying the pathological area are occluded.

Case description. The article presents a case report of recurrent massive pulmonary hemorrhage that debuted in a 40-year-old woman with no previous pulmonary history. Inpatient treatment included tracheobronchoscopy, bronchial occlusion of the bleeding lung, obstruction of the contralateral bronchial tree, X-ray endovascular occlusion of the bronchial arteries. Pulmonary hemorrhage recurred. Repeated occlusion of the systemic lung arteries arrested the bleeding for a period. Results. Induced emergency pneumonectomy was performed at the height of recurrent pulmonary hemorrhage. Death occurred on the 6th postoperative day because of advancing nosocomial pneumonia.

Conclusion. The above case report demonstrates the difficulties of managing massive pulmonary hemorrhage in rare lung vascular malformations and multiple sources of bleeding. Occlusion of the lower diaphragmatic artery, one of the major bleeding arterial collectors, failed, which caused asphyxiating hemorrhage. Surgically successful emergency pneumonectomy resulted in death due to nosocomial pneumonia of a single lung.

1. Паламарчук Г.Ф., Акопов А.Л., Арсеньев А.И. и др. Бронхоскопия в диагностике и лечении заболеваний органов дыхания. Санкт-Петербург: Изд-во «Фолиант»; 2019: 328. [Palamarchuk G.F., Akopov A.L., Arsenyev A.I. et al. Bronchoscopy in the diagnosis and treatment of respiratory diseases. Saint Petersburg: Folio Publ.; 2019: 328 (In Russ.)].

2. Ittrich H, Bockhorn M, Klose H, Simon M. The diagnosis and treatment of hemoptysis. Dtsch Arztebl Int. 2017; 114(21): 371-381. doi: 10.3238/arztebl.2017.0371

3. Григорьев Е.Г., Пак В.Е., Пачерских Ф.Н. Легочное кровотечение. Руководство. М.: ГЭОТАР-Медиа; 2023: 128 [Grigoryev E.G., Pak V.E., Pacherskikh F.N. Pulmonary hemorrhage. Guide. M.: GEOTAR-Media Publ.; 2023:128 (In Russ.)].

4. Frood R., Karthik S., Mirsadraee S. et al. Bronchial artery embolization for massive haemoptysis: immediate and long-term outcomes – a retrospective study. Pulm Ther. 2020;6(1):107–117. doi: 10.1007/s41030-020-00112-x

5. Хайрутдинов Е.Р., Цуркан В.А., Араблинский А.В. Непосредственные результаты эндоваскулярной эмболизации у пациентов с легочными кровотечениями. Международный журнал интервенционной кардиоангиологии. 2017; 48–49:91 [Khayrutdinov E.R., Tsurkan V.A., Arablinskiy A.V. Immediate results of endovascular embolization in patients with pulmonary hemorrhage. International Journal of Interventional Cardioangiology. 2017;48-49:91 (In Russ.)] URL: https://cyberleninka.ru/article/n/neposredstvennye-rezultaty-endovaskulyarnoy-embolizatsii-u-patsientov-s-legochnymi-krovotecheniyami-1/viewer [access date: 18.12.2024].

6. Seyyedi S.R., Sadeghipour P., Sadr M. et al. Outcomes and Complications of Bronchial Angioembolization in Patients with Massive Hemoptysis. Tanaffos. 2019;18(4):310-314. URL: https://pubmed.ncbi.nlm.nih.gov/32607111/ [accessed:: 18.12.2024].

7. Li Y., Jia Z., Li S. et al. Factors associated with long-term haemoptysis recurrence after transarterial embolisation for haemoptysis. Int J Tuberc Lung Dis. 2020;24(6):606-611. doi:10.5588/ijtld.19.0490

8. Gavioli E., Aung C.C. Haemoptysis management in cystic fibrosis: A case report and treatment pathway. J Clin Pharm Ther. 2020;45(4):845-847. doi:10.1111/jcpt.13179.

9. Kathuria H., Hollingsworth H.M., Vilvendhan R., Reardon C. Management of life-threatening hemoptysis. J Intensive Care. 2020;8:23. doi:10.1186/s40560-020-00441-8.

10. Prey B., Francis A., Williams J., Krishnadasan B. Evaluation and Treatment of Massive Hemoptysis. Surg Clin North Am. 2022;102(3):465-481. doi:10.1016/j.suc.2021.11.002.

11. Респираторная медицина: 2 том. Под ред. А.Г. Чучалина. 2-е издание, переработанное и дополненное. Москва: Издательство «Литтерра»;2017:277-305. [Respiratory Medicine: volume 2. Edited by A.G. Chuchalin. 2nd edition, revised and supplemented. Moscow: Litterra Publishing House; 2017:277-305 (In Russ.)].

12. Walker C.M., Rosado-de-Christenson M.L., Martínez-Jiménez S. et al. Bronchial arteries: anatomy, function, hypertrophy, and anomalies. Radiographics. 2015;35(1):32-49. doi: 10.1148/rg.351140089

13. Shi X., Wang M., Wang Y. et al. A case of bronchial Dieulafoy disease and literature review. J Cardiothorac Surg. 2023;18(1):197. doi: 10.1186/s13019-023-02279-1

14. Tao Y., Li J., Su R. et al. The efficacy, safety, and related factors of bronchial artery embolization for hemoptysis: a systematic review and meta-analysis with subgroup analysis. Cardiovasc Diagn Ther. 2024;14(5):859-877. doi: 10.21037/cdt-24-157

15. Karlafti E., Tsavdaris D., Kotzakioulafi E. et al. Which Is the Best Way to Treat Massive Hemoptysis? A Systematic Review and Meta-Analysis of Observational Studies. J Pers Med. 2023;13(12):1649. doi: 10.3390/jpm13121649