Treatment of pediatric bronchial Dieulafoy’s lesion by ethylene vinyl alcohol copolymer embolization

Dieulafoy’s lesions are a rare condition characterized by abnormally dilated submucosal arteries. For the first time we successfully treated a pediatric case of bronchial Dieulafoy’s lesion by embolization with liquid embolic agent ethylene vinyl alcohol copolymer (Onyx). A 9-year-old, previously healthy female developed repeated hemoptysis of approximately 100 milliliters per day of bright red blood within a fortnight without notable causes. She took oral medication as she did not present with other symptoms, until an episode of massive hemoptysis sent her into local intensive care unit, and then she was referred to our hemoptysis center. Bronchoscopy showed a mild-sloped protrusion at the opening of the right lower lobe. Gentle pressing of it with a closed forcep felt slightly “bouncing”. Chest CT revealed no abnormality apart from scattered patches of ground glass opacity which were old blood. Computed tomography angiography (CTA) showed vascular tortuosity without dilation. The traveling path of a branch of the right bronchial artery matched the location of the protrusion. When the culprit vessel was occluded successfully by embolization using Onyx, the protrusion shrank, and no further hemoptysis was observed. Endovascular embolization is the preferred treatment for Dieulafoy's lesions due to minimal invasiveness, but it is limited by technical difficulty and reccurence rates. Compared to conventional embolic agents, the liquid Onyx is non-adhesive and lava-like, conducive to thorough embolization of distal collateral culprit vessels without accidental occlusion of healthy ones, making it a great tool for pulmonary vascular embolization.