ENDOVASCULAR BRONCHIAL ARTERY EMBOLIZATION IN LIFE-THREATING HEMOPTYSIS. A CASE REPORT

Introduction: Hemorrhage arising from a bronchial arterial source is the most common cause of life-threatening hemoptysis, which is defined as the expectoration of blood originating from the pulmonary parenchyma or the tracheobronchial tree. Significant hemoptysis originates from the bronchial arteries in 90% of cases. It can be acute and can present as medical emergency. Bronchial artery embolization is considered to be the primary and most effective method when confronting a massive hemoptysis. The procedure requires an angiographic study of the anatomy of the bronchial vessels. The artery is reached by a femoral or brachial approach, using a catheter and under fluoroscopic visualization. The embolization may be performed with different agents - particles, gelaspon, coils or glue.Materials and Methods: The case report describes a 9-year-old girl who was admitted with massive hemoptysis. She had to be intubated, with previous anterior and posterior nose tamponade. The girl was admitted with no further complaints or symptoms except the expectoration of blood. Conservative treatment was not effective and after a following attack of massive bleeding she underwent a bronchial artery catheterization. It showed with accuracy the site of hemorrhage to be from the right inferior branch of the vessel, and intra-arterial embolization was performed.Results: The procedure was well tolerated and, as a result, high clinical success was achieved in managing the bleeding. The patient was discharged with no further complications.Conclusion: Bronchial artery embolization is a well-established and well-tolerated procedure. It comes with a better outcome than medical, surgical, or bronchoscopic techniques, especially when facing an acute massive hemoptysis

Extranodal natural killer/t-cell lymphoma - nasal type - `midline lethal granuloma` - a case report

Introduction: The numerous lymphoid neoplasms vary widely in their clinical presentation and behaviour, and thus all present challenges to clinicians. Approximately 0.17 - 1.5% of all Non Hodgkin`s lymphomas (NHL) are with a fractional amount involving the nasal cavity and paranasal sinuses. NHL nasal type is rare and aggressive. It typically causes local destructive midfacial necrotizing lesions, damaging of cartilage, bone and soft tissues. However, extranodal type of NHL is hard to recognize and treat.Materials and methods: A 70-year old female patient was admitted to the the `St. Marina`, University Hospital, Varna complaining of recurrent episodes of nasal infections and night sweating.Results: A physical examination reveals a palpable mass on the right side of the nasal cavity that caused partial nasal obstruction, breathing problems. In addition to that, splenomegaly (140/56mm) was found. An extended parenchymal structure infiltrating the underlying soft tissues of the right ala nasi 75/23mm in size was found during a computed tomography scan. Differential diagnosis between neuroblastoma and lymphoma was considered after performing a biopsy. Subsequent immunohistochemical tests and trephine biopsy confirm the diagnosis to be Extranodal NHL. The patient was admitted to the Haematology Department for chemotherapy with regime CHOEP - Vincristine, Etoposide, Endoxan, Episindan and Prednisolone. Haematological partial response was achieved after only three cycles of the therapy. The treatment was followed up by radiotherapy.Conclusion: Non Hodgkin`s Lymphoma nasal type is considered as a fast progressing, nonrelenting tumor. Its ambiguous symptoms and the difficulties of obtaining a histological diagnosis result in postponement of the initial therapy. Despite that, advancements in immunohistochemistry help in achieving admirable results