A case of ligation of the bronchial artery for hemoptysis

A 33-year-old man was admitted to our hospital because of hemoptysis. Bronchoscopic examination revealed coagulated blood at the lingular segmental bronchus. After removing the coagulated blood, no abnormal neoplastic lesion or aneurysm could be seen. Chest CT showed no chronic inflammatory disease of the lung, nor bronchodilatation. Hemoptysis recurred, and enlarged bronchial arteries could be observed by 3D-CT. Bronchial artery embolization was considered, but not performed, because of possible systemic embolization with high-flow shunting. Instead, bilateral ligation of the bronchial artery was performed employing video-assisted thoracic surgery (VATS). After surgery, hemosputum ceased by the 10th post-operative day. No hemoptysis occurred for 5 months after surgery. Eight cases of ligation of the bronchial artery in Japan have been previously reported in the literature, of which 7 were for racemose hemangioma of the bronchial artery, and one for bronchial aneurysm. Hemoptysis recurred in 2 of these 8 cases between 1 and 14 years after surgery. Although ligation of the bronchial artery is an effective treatment, long-term observation is needed to monitor the possible recurrence of hemoptysis.