所属 医学部 医学科（東京女子医科大学病院） 職種 助教
|発表タイトル||Successful treatment of primary racemose hemangioma of the bronchial artery using expandable hydrogel polymer coil|
|会議名||CSI Frankfurt 2017|
|主催者||The CSI Foundation|
|発表者・共同発表者||◎KOGURE Tomohito, SUGIYAMA Hisashi, ISHII Tetsuko, BOKU Hitomi, HAGIWARA Nobuhisa|
|概要||A 2-year-old boy had recurrent hemoptysis and respiratory insufficiency and required long-term mechanical ventilation support for the repeated life-threatening hemoptysis. The chest X-ray showed consolidation shadows in the bilateral lower lobes. The enhanced CT showed numerous complex abnormal arteries on the surrounding of the carina and bilateral bronchus. Angiography revealed a complex, tortured and dilated bronchial arteries. Judging from his CT findings, primary racemose hemangioma of a bronchial artery was diagnosed. To prevent from recurrent hemoptysis and withdraw from mechanical ventilation, coil embolization for these lesions was planned. Catheter examination showed mean pulmonary artery pressure of 24 mmHg and pulmonary systemic blood flow ratio of 1.7. Angiography showed multiple plexus like abnormal vessels in the surrounding of the carina and bilateral bronchus. Left ventricular cavity was mildly dilated.
Total 40 pieces of expandable hydrogel polymer coil and bare metal coil were implanted. Abnormal pulmonary blood flow remarkably decreased after coil embolization. Hemoptysis did not recur and his respiratory insufficiency improved immediately. He has shown a good clinical course without recurrent hemoptysis for 2 years since.
Racemose hemangioma is a rare vascular malformation, especially in children. Previous studies reported the coil embolization for racemose hemangioma was temporally effective, but the efficacy was limited in many cases because of plexus-like complex abnormal vessels, which connected each other. Most cases required lung lobectomy. Consequently, short-segmental embolization was considered to be not effective for prevention of hemoptysis. Furthermore, recurrent of hemoptysis after coil embolization was not rare in the racemose hemangioma because of recanalization. Therefore, we believed embolization for whole segment of abnormal vessels by non-recanalization material such as hydrogel material was essential.
Expandable hydrogel polymer coil has greater filling and mechanical stability and it could be effective against recanalization in racemose hemangioma.