Figure 2.

A 63-year-old woman who presents with massive hemoptysis. She has a known history of Histoplasmosis for which a right lower lobe wedge resection was performed approximately 15 years ago. In the resection margin, the patient has developed a partially calcified cavitary lesion which has been slowly increasing in size. Bronchoscopic biopsies performed approximately one month earlier were negative for malignancy. (A) Coronally reconstructed CT image demonstrates a partially calcified cavitary mass in the right lower lobe (arrowhead). Calcified left hilar nodes are noted as well (arrow); (B) digital subtraction angiogram from a selectively catheterized right ICBT demonstrates a hypertrophied lower branch of the artery supplying a hypervascular lesion (arrows). Incidentally noted is a hypervascular nodule in the upper lobe that corresponds to another nodule in the right upper lobe seen on CT (not shown); (C) unsubtracted angiogram demonstrates that the lower branch of the right has been selectively catheterized using a microcatheter. Embolization of this branch of the bronchial artery was performed using 300–500 µm microspheres; (D) post embolization angiogram from the proximal right ICBT demonstrates no flow to the embolized branch or right lower lobe lesion. It was felt that the large right lower cavitary lesion was the likely culprit for the patient’s hemoptysis and hence the upper lobe branch was not embolized. Unfortunately, two days later the patient had repeat hemoptysis and was brought back down to the angiography suite; (E) pulmonary angiogram was performed which did not demonstrate any abnormalities; (F) selective catheterization of the upper branch of the right ICBT redemonstrates the hypervascular right upper lobe nodule. Embolization with 400 µm microspheres was performed (not shown). After this, the patient did not have repeat hemoptysis till her elective right lower lobectomy.