Fig. 3

The patient with old pulmonary tuberculosis was hospitalized for 2 days with intermittent hemoptysis. The maximum hemoptysis volume in 24 h was approximately 700ml. A. Chest enhanced CT showing old lesions in the upper lobe of the right lung (white arrowhead). The left upper lobe cavity (white arrow) was formed, and PAP was observed in the cavity (black arrow). B. Right intercostal bronchial artery (black arrow) angiography shows obvious thickening, increased number, disorder, and structural abnormality of the bronchial artery (white arrowhead) and premature pulmonary artery branch (white arrow) in the upper lobe of the right lung. C. Right intercostal bronchial arteriography shows reverse flow in the late stage of the artery. The angiography also shows the pulmonary artery (black arrow) in the upper lobe of the right lung. D. After intercostal bronchial artery embolization with 350-560 μm PVA particles, the main intercostal artery remained intact. The bronchial artery and its branches disappeared completely, indicating complete embolization. E. Left bronchial artery (black arrow) angiography shows obvious thickening, increased number, disorder, and structural abnormality of the bronchial artery (white arrow). No obvious PA or PAP was observed. F. Left bronchial artery angiography again shows left BA branch vessels disappeared post BAE in 350-560 μm PVA particles. G. PAP showed on the left upper lobe of the lung by introducing a single curved catheter assisted by the long vascular sheath (black arrow) pulmonary angiography. H. PAP (white arrow) rupture, and contrast agent entering the cavity (black arrow) as observed in pulmonary angiography. I. Angiography after PAPE + PAE with micro coils, dense embolization with micro coils in parent artery (black arrowhead), and displacement of the micro coils at PAP rupture (black arrow). J. The patient was discharged from the hospital and admitted again with hemoptysis 13 months later. The amount of hemoptysis was about 100ml within 24 h. Enhanced chest CT examination showed that the cavity in the upper lobe of the left lung (black arrow) was smaller than before, and the shadow of the micro coils was visible within it (black arrowhead). K. Left intercostal artery (black arrowhead) angiography shows a large number of collateral vessels (black arrows) deviating into the lung, forming a large number of tortuous, thickened, malformed vessels, pulmonary artery fistula (white arrow), and micro coils shadow (white arrowhead). L. The presence of the main intercostal artery (black arrow) and the disappearance of collateral malformed vessels and pulmonary artery fistula were angiographed with 350-560 μm PVA embolization