A case of radiation pneumonitis caused by treatment of lung cancer which revealed marked hypervasculality on bronchial arteriography

A 44-year-old man was admitted to our hospital because of hemoptysis. He had been admitted to our ward in June 1991, after resection of a brain tumor at another hospital due to cerebral metastasis of lung cancer (adenocarcinoma). Systemic chemotherapy and pulmonary irradiation therapy were performed during the first hospitalization. Radiation pneumonitis occurred 1 month after the completion of radiotherapy, which responded to administration of corticosteroids. One year and 4 months later after the completion of radiotherapy, he was readmitted to our hospital because of hemoptysis. Chest computed tomogram and bronchoscopy showed no recurrence of lung cancer, so pulmonary arteriography and bronchial arteriography were performed to investigate the cause of hemoptysis. Pulmonary arteriograms showed diminished vascularity in the area of radiation fibrosis, but a bronchial arteriogram showed inflammatory hypervascularization in the same field. We considered that the bronchial arterial angiogenesis induced by radiation pneumonitis was the cause of hemoptysis. Bronchial arteriography is necessary in cases of radiation pulmonary fibrosis with hemoptysis without obvious recurrence of tumor. If the growth of new blood vessels in the bronchial artery can be induced by radiation therapy, the administration of anti-cancer agents to the bronchial artery should be considered in the treatment of recurrent lung cancer after radiation therapy.