Chest
Volume 135, Issue 5, May 2009, Pages 1355-1358
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Selected Reports
Medical Pneumonectomy: Interventional Bronchoscopic and Endovascular Management of Massive Hemoptysis Due to Pulmonary Artery Pseudoaneurysm, a Consequence of Endobronchial Brachytherapy

https://doi.org/10.1378/chest.08-2091Get rights and content

Endobronchial brachytherapy serves as an excellent adjunct to standard external beam radiation therapy. The high dose of local radiation is still used to manage airway obstructions at some institutions, despite the well-known risks of airway fistulae to the esophagus or cardiovascular structures. A less reported complication is the development of a pulmonary artery pseudoaneurysm into the mainstem bronchi. The formation of an arterial pseudoaneurysm can lead to massive hemoptysis, which often is fatal. We present a case of massive hemoptysis due to this complication of brachytherapy managed entirely through bronchoscopic and endovascular techniques.

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Discussion

Endobronchial brachytherapy serves well in treating residual or recurrent carcinoma. It can be effective for patients who have been treated with maximal doses of external beam radiation. However, it can be potentially dangerous. Massive hemoptysis and mediastinal fistulae are the most common complications.1

Traumatic, infectious, rheumatologic, and malignant causes of pulmonary artery pseudoaneurysm have been well documented in the literature. It is an uncommon yet well-known iatrogenic

Conclusions

Massive hemoptysis is a significant risk of endobronchial brachytherapy. Pulmonary artery pseudoaneurysm can result at a delayed time from initial therapy. This entity can be successfully managed through bronchoscopic and endovascular techniques.

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