Emergent Lung Resection for Massive Hemoptysis From Bronchial Malformation

Area of Science:

• Vascular Surgery
• Interventional Pulmonology
• Thoracic Surgery

Background:

• Bronchial arteriovenous malformations (BAVMs) are rare vascular anomalies.
• Typically asymptomatic, BAVMs can rupture, leading to life-threatening hemoptysis.
• Standard treatment includes transcatheter embolization, with surgery for refractory cases.

Observation:

• A patient presented with massive hemoptysis due to a ruptured BAVM.
• Initial endovascular management was unsuccessful due to complex anatomy and hemodynamic instability.
• The patient required emergent extracorporeal membrane oxygenation (ECMO).

Findings:

• Despite initial embolization attempts, massive hemoptysis persisted.
• Hemodynamic instability complicated endovascular procedures.
• Successful management required a multidisciplinary approach, including ECMO and surgical resection.

Implications:

• This case highlights the challenges in managing ruptured BAVMs with unfavorable anatomy.
• Emergent ECMO can serve as a bridge to definitive surgical treatment.
• Right bilobectomy proved necessary for controlling severe hemoptysis in this complex case.