Endovascular embolization of a ruptured bronchial artery pseudoaneurysm in an elderly female

Bronchial artery pseudoaneurysm (BAP), pathologically defined as a contained hematoma, is a rare pathology with few reported cases (approximately 60) in the literature. In circumstances where patients are critically ill, prompt diagnosis and treatment are required. A 73-year-old woman with a history of coronary artery disease and interstitial lung disease presented with chest pain and dyspnea. She was hypotensive and anemic on arrival. Computed tomography (CT) angiography revealed a ruptured bronchial artery pseudoaneurysm with a large mediastinal hematoma. Endovascular embolization using N-butyl cyanoacrylate (NBCA) glue and Lipiodol achieved successful occlusion of the pseudoaneurysm. Computed tomographic angiography (CTA) is the investigation of choice to screen for the disease, with digital subtraction angiography (DSA) being the gold standard for confirmation and guiding management. With recent advances in interventional procedures and vascular access techniques, transcatheter embolization has become the first-line management option for managing these cases. In this case report, the pertinent anatomy, work-up, imaging findings, and overview of the interventional procedure technique are discussed.