title: Massive hemoptysis from pulmonary ligament artery supplying abnormal basal segments of the lower lobe.
abstract: BACKGROUND
  Non-bronchial systemic arteries can be a significant source of massive hemoptysis in patients with marked pleural involvement. However, in some cases without pleural involvement, the pulmonary ligament artery (PLA) can also enter the abnormal lung parenchyma and be responsible for hemoptysis.
  
  
  OBJECTIVE
  To discuss the factors influencing the development of a blood supply from the PLA in patients with hemoptysis.
  
  
  METHODS
  Seventy-five consecutive patients who underwent bronchial artery embolization (BAE) for massive hemoptysis were evaluated between January 2006 and December 2011 retrospectively. Selective arteriography showed an enlarged and tortuous PLA in five patients. CT was done to determine the site and extent of the underlying diseases before BAE in all patients. Angiographic and CT images were analyzed to determine if there was a relationship between PLA supply and location of the underlying disease or mediastinal pleural involvement.
  
  
  RESULTS
  The underlying lesions of six patients involved the basal segments of the lower lobe without marked mediastinal pleural thickening or adhesion, but diaphragmatic and lateral pleural thickening was observed in one case. Of these six patients, the PLA supplied blood to the lesions related to the hemoptysis in five patients. No patient with massive hemoptysis whose underlying lesions involved other segments of lung had a PLA supplying the lesions.
  
  
  CONCLUSIONS
  Even though pleural involvement is absent, underlying lesions involving the basal segments of the lower lobe could be a good indicator that the PLA is the cause of bleeding in patients with massive hemoptysis.
authors.affiliation: Department of Vascular Surgery, the Second Affiliated Hospital of Soochow, Suzhou, China.
authors.forename: Zhen-Sheng
authors.initials: ZS
authors.lastname: Liu
authors.forename: Xiao-Qiang
authors.initials: XQ
authors.lastname: Li
authors.forename: Cheng
authors.initials: C
authors.lastname: Li
authors.forename: Long-Jiang
authors.initials: LJ
authors.lastname: Zhou
authors.forename: Jia-Xiang
authors.initials: JX
authors.lastname: Wang
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Yong
authors.initials: Y
authors.lastname: Sun
authors.forename: Xiong-Wei
authors.initials: XW
authors.lastname: Kuang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D003287:Contrast Media; D004621:Embolization, Therapeutic; D005260:Female; D006469:Hemoptysis / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008168:Lung / Q000098:blood supply* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media
keywords: Hemoptysis; bronchial artery; computed tomography (CT); pulmonary ligament artery; transarterial embolization