Chest
Chest
Volume 118, Issue 1, July 2000, Pages 269-270
Selected ReportsUnilateral Diaphragmatic Paralysis Following Bronchial Artery Embolization for Hemoptysis
Bronchial artery embolization is an effective treatment for patients with hemoptysis . Serious complications are rare, but may occur if the arterial supply to other structures is compromised. We present a case of unilateral diaphragmatic paralysis following bronchial artery embolization in a patient with cystic fibrosis. We believe that the diaphragmatic paralysis was due to the inadvertent obstruction of the left pericardiacophrenic artery during the embolization procedure, with compromise of the phrenic nerve blood supply. This resulted in a significant loss of lung function in our patient, who did not recover despite the subsequent return of diaphragmatic function.
Section snippets
Case Report
A 29-year-old woman with cystic fibrosis and severe cystic bronchiectasis presented with recurrent hemoptysis. There was a 2-year history of minor hemoptysis < 50 mL in association with exacerbations of her bronchiectasis, and there was an episode of recurrent hemoptysis of between 50 and 200 mL for 4 days that had resolved with rest and IV antibiotics.She presented with further hemoptysis, having hemorrhages of between 200 and 300 mL on 3 consecutive days, and underwent bronchial angiography
Discussion
Recent studies have shown that major hemoptysis in people with cystic fibrosis can be safely and effectively treated with bronchial artery embolization, with immediate control of hemoptysis in 84 to 100% of those treated.2, 3, 4 Apart from chest pain, fever, and transient dysphagia, no significant complications have been reported in these studies.
Unilateral diaphragmatic paralysis is often asymptomatic, but up to 24% of people with this condition experience persistent shortness of breath,5
References (6)
- ThompsonAB et al.
Pathogenesis, evaluation, and therapy for massive hemoptysis.
Clin Chest Med
(1992) - SweezeyNB et al.
Bronchial artery embolization for severe hemoptysis in cystic fibrosis.
Chest
(1990) - PiehlerJM et al.
Unexplained diaphragmatic paralysis: a harbinger of malignant disease?
J Thorac Cardiovasc Surg
(1982)
There are more references available in the full text version of this article.
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Haemoptysis and bronchial artery embolization in children
2008, Paediatric Respiratory ReviewsCitation Excerpt :Spherical embolic agents such as Embospheres (Biosphere, Rockland, MA, USA) have also been advocated for BAE,18,33 but with these it may be necessary to use larger sizes than for PVA (say 500 μm).31 Metal coils are rarely appropriate for BAE,7,17,29 despite some published recommendations.5,8,11,12,22,29,30,34–36 They occlude large arteries, meaning that recurrent haemoptysis is likely because of revascularization by collaterals, and they limit options for future BAE.7
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Copyright © 2000 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.