左甲状頸動脈から分岐する異所性右気管支動脈を責任血管とする喀血に対して気管支動脈塞栓術を施行した1例

A case of endovascular embolization of right bronchial artery originating from left thyrocervical trunk：a rare anomalous origin

喀血をきたす原因疾患は多岐にわたり，その病態に応じて保存的治療から手術療法まで様々な治療が選択される。Rémyらが大量喀血に対する気管支動脈塞栓術（bronchial artery embolization：BAE）の有効性を報告して以来，喀血に対するBAEの適応は広がりつつある^1）。BAEを必要とする喀血において責任血管の90％は気管支動脈とされるが，気管支動脈には様々な破格があることが報告されている^2）3）。今回我々は，左甲状頸動脈から分岐する異所性右気管支動脈に対してBAEを施行し良好な経過をたどった1例を経験したので，若干の文献的考察を加えて報告する。

We report a man in his 70s complained massive hemoptysis. He had been given a diagnosis of bronchiectasis and had been treated with bronchial artery embolization（BAE）twice. Multidetector-row computed tomography（MDCT）revealed hemoptysis from bilateral lung lobes and three dilated bronchial arteries. One of them was an ectopic right bronchial artery originating from left thyrocervical trunk. BAE with gelatin sponge was performed and immediate cessation of hemoptysis was obtained. Nine months later, he presented with hemoptysis and BAE was performed again. Although there are numerous anatomical variations in bronchial arteries, we believe that it is important to evaluate the anatomy of bronchial arteries before performing BAE, including rare anomalous origin.