A 58-year-old man with a treated history of pulmonary tuberculosis presents with massive hemoptysis, expectorating over 300 mL of blood in 24 hours. Bronchoscopy localizes the bleeding to the right upper lobe. CT angiography shows a dilated hypertrophied right bronchial artery. The most appropriate interventional radiological procedure is:
- A Pulmonary artery coil embolization
- B Transvenous retrograde venous occlusion
- C Bronchial artery embolization ✓
- D Endobronchial balloon placement under fluoroscopy
Correct answer: C. Bronchial artery embolization
Explanation
Massive hemoptysis almost always arises from the systemic bronchial circulation rather than the pulmonary arteries, so bronchial artery embolization is the standard first-line treatment when conservative measures fail. The hypertrophied bronchial artery seen on CT angiography confirms the source. Pulmonary artery embolization is reserved for rare cases where a pulmonary arterial cause such as a Rasmussen aneurysm is demonstrated.
Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.
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