Navigating complexity and sealing the threat: Ultrasound and CT guided percutaneous glue embolization of bronchial artery pseudoaneurysm with challenging anatomy

Bronchial artery aneurysms are a rare vascular pathology, however bronchial artery pseudoaneurysms are even less commonly observed with minimal cases available in the literature. They are often associated with conditions such as lung infections or malignancies and are typically managed with endovascular embolization. However, complex vascular anatomy may render endovascular approaches unsuitable. Both pathologies require prompt diagnosis and management due to the risk of rupture and subsequent bleeding. This case report aims to describe the diagnosis and successful percutaneous treatment of a bronchial artery pseudoaneurysm of a 59-year-old female patient who presented with hemoptysis on the background of cavitating lung disease secondary to aspergillus colonization. The patient underwent successful percutaneous glue embolization opposed to the typical endovascular approach due to difficult anatomy, leading to complete resolution of the hemoptysis. This case report highlights the importance of US-guided direct percutaneous embolization of a bronchial artery pseudoaneurysm with the use of n-butyl-2-cyanoacrylate as a safe and effective treatment option when endovascular therapy cannot be performed.