1Georgio Chidiac, 2Fadi Tannouri, 3Emmanuel Ammanouil, 2Celine El Haddad, 4Rayan El Amine
1Department of Dermatology, University Hospital Center – Notre Dame Des Secours, Byblos, Lebanon; 2Department of Diagnostic Radiology, Université Libre De Bruxelles, Brussels, Belgium; 3Department of Diagnostic Radiology, Lebanese American University, Beirut, Lebanon; 4Department of Diagnostic Radiology, University Hospital Center – Notre Dame Des Secours, Byblos, Lebanon
Systemic arterial supply to the basal lung without sequestration is a rare congenital anomaly. The treatment of choice is usually a surgical resection of the affected portion of the lung. However, transarterial embolization has been recently considered as a minimally invasive alternative.
We report the case of a 23-year-old man who presented to the ER in August 2018 with one episode of hemoptysis. Physical examination was normal. Contrast-enhanced computed tomographic scan demonstrated an anomalous systemic artery of 8 mm in diameter emerging from the descending aorta at the level of T10 and supplying the base of the right lung (figure 1). Cardiothoracic surgeons and interventional radiologists informed the patient of the therapeutic options, ranging from continued monitoring to surgery. Despite the lack of enough data on the long-term results and the need for follow-up, the patient chose the endovascular option because it is a minimally invasive procedure. Retrograde puncture of the right superficial femoral artery was realized, and embolization of the aberrant artery with six detachable 0.035-inch metallic coils (Interlock-35 Fibered IDC) (Boston Scientific, USA) was done. The procedure was successful with no complications. Chest pain was the only reported symptom and was treated with analgesics. At three-month follow-up, no pulmonary infarct was observed (figure 2), and no clinical symptoms such as hemoptysis were reported after two years.
In our case, a CT angiography was realized after the first episode of hemoptysis. This stresses on the importance of investigating any inaugural hemoptysis especially at a young age as congenital anomalies tend to be more frequent. In patients with hemoptysis associated with aberrant arterial supply to the normal lung, coil embolization is an effective and safe therapeutic option.