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| Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access |
| Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc |
| Journal website http://www.jocmr.org |
Case Report
Volume 3, Number 5, October 2011, pages 275-277
Multiple Systemic Infarctions as a Complication of Bronchial Artery Embolization With Polyvinyl Alcohol: A Case Report
Abdullah Ozkoka, c, Ayse Serra Ucara, Timur Selcuk Akpinara, Gulfer Okumusb, Esen Kiyanb, Orhan Arsevenb
aIstanbul Faculty of Medicine, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
bIstanbul Faculty of Medicine, Department of Chest Medicine, Istanbul University, Istanbul, Turkey
cCorresponding author: Abdullah Ozkok, Istanbul Faculty of Medicine, Department of Internal Medicine, Istanbul University, 34390, Fatih/Istanbul/Turkey
Manuscript accepted for publication August 16, 2011
Short title: Bronchial Artery Embolization With Polyvinyl Alcohol
doi: https://doi.org/10.4021/jocmr665w
| Abstract | ▴Top |
Bronchial artery embolization (BAE) is a widely used modality of treatment for massive hemoptysis which has well known complications such as chest pain, groin hematoma and transverse myelitis but systemic embolization of the material used in the procedure is very rare and was reported only four times in the literature which were all caused by the use of microspheres. Herein we report a case of a 41-year-old caucasian male who had a history of tuberculosis 10 years ago. He had BAE with polyvinyl alcohol (PVA) for the treatment of recurrent hemoptysis. After the procedure, the patient complained of severe pain on the left upper quadrant and bilateral costovertebral regions and in abdominal CT, multiple infarcts in the subcapsular area of the spleen and kidneys were observed. This is the first reported case of inadvertent systemic embolization secondary to BAE with PVA. Although the risk of systemic embolization is greater with microspheres, still potentially serious and life threatening complications may occur with PVA.
Keywords: Bronchial artery emobolization; Complication; Polyvinyl alcohol
| Introduction | ▴Top |
Bronchial artery embolization (BAE) is a well-accepted and effective form of treatment for massive and recurrent hemoptysis but some potentially life threatening complications including organ infarcts due to inadverent systemic embolization of material used in the procedure may occur. We present a case of multiple infarcts in the spleen and kidneys secondary to bronchial artery embolization with polyvinyl alcohol (PVA).
| Case Presentation | ▴Top |
A 41-year-old caucasian male who had a history of tuberculosis 10 years ago was referred to our clinic for BAE for the treatment of recurrent hemoptysis of 30-50 cc per day for the last 3 months. Thorax and abdominal CT were performed for the suspicion of a malignancy. Abdominal CT was totally normal (Fig. 1) and thorax CT demonstrated only fibrotic sequels and bronchiectatic lesions in the apical segment of the right upper lobe and pleuroparenchymal sequel band formations in the superior segment of the right lower lobe and no sign of a malignancy. The source of the hemoptysis was considered to be these sequel lesions secondary to past pulmonary tuberculosis.
 Click for large image | Figure 1. Abdominal CT is completely normal before the bronchial artery embolization. |
| Discussion | ▴Top |
BAE has various reported complications which may be severe and life threatening such as spinal cord infarction, transverse myelitis [1], myocardial infarction [2], serebrovascular accident [2-4], splenic and renal infarcts [3], esophagobronchial fistula [5], diaphragmatic paralysis [6], infarction of the bronchus [7], subintimal dissection of aorta [1,8], arterial perforation [8], mediastinal hematoma [1], or mild and self-limited such as chest pain [1,8], shoulder pain [8], transient dysphagia [8,9], transient cortical blindness [10], transient left orbital and forehead pain [9] and groin hematoma [8].
Systemic embolization during BAE is a very rare complication and to our knowledge there are only four reported cases including infarcts in the spleen and kidneys, myocardial infarction and serebrovascular accident [2-4]. Embolization materials used in these reports were microspheres. Our case is the first report of systemic embolization due to BAE with PVA.
We postulate that PVA had traversed from the bronchial circulation into the pulmonary circulation and then into small pulmonary arteriovenous malformations, and finally into the systemic circulation causing multiple infarcts in the spleen and both kidneys.
Actually, the risk of systemic embolization is higher with microspheres when compared with PVA because PVA has variability in size and a tendency to aggregate. These properties limit the ability to embolize peripheral vessels and cross arteriovenous anastomoses; however, microspheres do not have these limitations [3].
Conclusion
We have presented the first case of inadvertent systemic embolization secondary to BAE with PVA. Although the risk of systemic embolization is greater with microspheres, still potentially serious and life threatening complications may occur with PVA.
| References | ▴Top |
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