A 57-year-old male arrived at the emergency room due to cardiac arrest. He had a history of diabetes and pneumonia six and two years prior, respectively, and underwent embolization treatment for hemoptysis five days prior and was discharged one day earlier. He was diagnosed with pulmonary and endobronchial tuberculosis and was prescribed medications for tuberculosis.
About one hour before arriving at the emergency room, about 700 mL of hemoptysis occurred. For the first angiography performed five days prior, the right interocostobronchial artery to the left lower lung, aberrant bronchial arteries from the left internal mammary artery supplying the left upper lung, and several left posterior intercostal arteries supplying the left lower lung were successfully embolized with PVA particles.
Computed tomography (CT) showed no enlarged bronchial arteries, and angiography of the descending thoracic aorta and left subclavian artery showed no systemic hypervascularization in either lung. Both coronary angiographies showed a CBF (sinoatrial nodal artery) from the right coronary artery coursing along the left main bronchus (Fig. 2). However, cannulation and embolization of CBF failed due to spastic changes of CBF and tachycardia. Bleeding through the endotracheal tube and hypoxemia persisted despite intensive care resulting in death two days after embolization.
Chest CT and angiography of right coronary artery in 57-year-old male, case 2. Right coronary angiography (C, D) shows coronary to bronchial artery fistula with spastic change from proximal right coronary artery running along superior and inferior walls of left main bronchus (arrows).