Pericardiophrenic artery embolisation for control of massive haemoptysis

Non-bronchial systemic arteries, apart from normal and anomalous bronchial arteries, may be a source of massive haemoptysis in a chronically inflamed lung via transpleural anastomoses. Transcatheter embolisation is an established therapeutic method of choice in the management of massive haemoptysis. We report embolisation of a hypertrophied pleural branch of the pericardiophrenic artery for the management of massive haemoptysis in a 61-year-old woman. Initial computed tomography chest imaging showed peribronchial thickening and subpleural scarring in the lingula lobe, with ground-glass changes secondary to haemoptysis. Angiography demonstrated a hypertrophied branch of the left pericardiophrenic artery supplying an abnormal bunch of vessels in the lingula and anastomosing with the homolateral inferior phrenic artery. This was successfully embolised with gel foam. The left internal thoracic artery was later embolised in order to control the repeat haemoptysis. A brief anatomical review of the source of massive haemoptysis, anatomy of the internal thoracic and pericardiophrenic arteries and the clinical implications are discussed.